The Centers for Medicare & Medicaid Services (CMS) has proposed revising its rules governing the process Medicare beneficiaries, providers, and suppliers use to appeal adverse determinations regarding claims for Medicare Part A and Part B benefits or determinations for Part D prescription drug coverage.  According to CMS, the revisions “would help streamline the appeals process and reduce administrative burden on providers, suppliers, beneficiaries, and appeal adjudicators.”

Among other things, the proposed rule would:

  • Allow appellants in Medicare Parts A and B claim and Part D coverage determination appeals to submit appeal requests without a signature.
  • Revise the timeframe for vacating a dismissal from 6 months to 180 days for a Medicare Part A or B claim or Medicare Part D coverage determination.
  • Provide that the date of receipt of the Administrative Law Judge (ALJ) or attorney adjudicator’s decision or dismissal is presumed to be 5 calendar days after the date of the notice of the decision or dismissal, unless there is evidence to the contrary.
  • Make a number of changes to the CMS January 17, 2017 final rule streamlining Medicare appeals procedures in order to revise “several provisions that, upon further review, pose unanticipated challenges with implementation.”
  • Make various technical corrections to address incorrect cross-references, inconsistent definitions, and confusing terminology.

Comments on the proposed rule will be accepted through December 3, 2018.