The Centers for Medicare & Medicaid Services (CMS) has proposed a rule that would establish a process for beneficiaries to appeal local or national Medicare coverage determinations.
Under the proposal, an administrative law judge (ALJ) would initially review appeals of local coverage determinations. The Department of Health and Human Services (HHS) Departmental Appeals Board would review appeals from national coverage determinations and from ALJ decisions on local coverage determinations. The board’s decisions could then be appealed to federal court.
The proposed rule would give beneficiaries an additional avenue to challenge the underlying coverage policy. Although beneficiaries already have the right to appeal individual claims denials, CMS says the new proposal is designed to ensure that complaints are reviewed in a predictable, uniform manner.
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