Wednesday, May 15, 2019

Changes to the Medicare Claims and Medicare Prescription Drug Coverage Determination Appeals Procedures

Nisha Hammel

On May 7, the Centers for Medicare & Medicaid Services (CMS) published the final rule titled Changes to the Medicare Claims and Medicare Prescription Drug Coverage Determination Appeals Procedures that provides Medicare beneficiaries, providers and suppliers clarifications on changes to the appeals process for adverse determinations under Medicare Part A and Part B and the prescription drug coverage under Part D.  CMS’ stated intent is to “…help streamline the appeals process and reduce administrative burden on providers, suppliers, beneficiaries and appeals adjudicators”.  AHCA/NCAL submitted comments on this very technical rule and CMS finalized most of the proposals supported by AHCA/NCAL including the removal of requirements that appellants sign appeal requests, change of timeframe for vacating dismissals from 6 months to 180 days and removal of redundant appeals processes.  The rule will go into effect July 8, 2019.

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