Lexology November 23, 2022
Every Medicare provider should understand the Medicare administrative appeals process. Providers are entitled to be reimbursed for their services and want to keep those reimbursements safe from audits. However, if Medicare makes an overpayment demand, understanding the process and what is required to defend those reimbursements can assist providers in better navigating the lengthy appeals process.
The Medicare administrative appeals process has five levels:
1st level: Request for Determination
2nd leve: Request for Reconsideration
3rd level: Request for ALJ Hearing
4th level: Medicare Appeals Counsil
5th level: Federal District Court
However, the Medicare appeals process starts well before the first level listed above when a provider receives a...
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