The Centers for Medicare & Medicaid Services (CMS) has issued a final rule streamlining the process for Medicare Parts A and B claims appeals and for Medicare Part D coverage determination appeals in order to “reduce associated burden on providers, beneficiaries, and appeals adjudicators.”  In particular, the final rule:

  • Removes the requirement in Medicare Parts A and B claim and Part D coverage determination appeals that appellants sign appeal requests (CMS estimates that 284,486 appeal requests are dismissed annually for not containing a signature).
  • Specifies that the timeframe for vacating a dismissal is 180 days instead of 6 months, since the number of days in a 6 month timeframe can vary.
  • Provides that the date of receipt of the Administrative Law Judge 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.
  • Amends CMS’s January 17, 2017 final rule streamlining Medicare appeals procedures to revise “several provisions that, upon further review, pose unanticipated challenges with implementation.”  Consequently, the final rule makes certain regulatory changes concerning amount in controversy, notices of hearings, notices of intent to participate in hearings, extensions of time to request hearings, dismissals of hearing requests, and notices of remand.
  • Makes technical corrections to the regulatory text to address incorrect cross-references, inconsistent definitions, and confusing terminology.

The rule is effective on July 8, 2019.