Article Detail - JE Part B
Appeals and Timely Filing
Make sure your staff is aware of the time frames, and which appeal should be submitted:
Timely Filing calculator - See first link below
Submitting a Reopening, instead of a Redetermination, could cause you to miss timely filing
Not an Appeal
- Reopening - 365 days from initial determination date
- Redetermination - 120 days from initial determination
- Reconsideration - 180 days from Redetermination date
- Administrative Law Judge - 60 days from Reconsideration receipt date
- Medicare Appeals Council Review - 60 days from ALJ hearing decision receipt
- Federal Court Review - 60 days from receipt of Medicare Appeals Council Review
- You send a Reconsideration 130 days after your remit date on a group of 20 claims for $10.000 each.
- A list is generated monthly and sent to Noridian for providers that send Reconsideration, instead of Redetermination.
- Then we send out education to everyone on the list (potentially 160 days past remit date now).
- On Day 170 you try to submit a Redetermination, but you are past timely filing.
- Your appeal is denied. There is NO late forgiveness for appeals.
- You have now lost $200,000.00
Submitting a reopening leaves your level of appeals open but always keep track of your timely filing dates
Appeals have shorter times allowed than Reopening
*Initial Determination Date - The date your claim processed the first time
- Noridian Medicare JE Part B Timeliness Calculators
- CMS Internet Only Manual (IOM) Publication 100-04 Chapter 29 Appeals of Claim Decisions
- CMS Internet Only Manual (IOM) Publiaction 100-04 Chapter 34 Reopening and Revision of Claim Determinatios and Decisions
Last Updated Mon, 29 Aug 2022 13:53:57 +0000