Transcription of Medicare Parts A & B Appeals Process
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Page 1 of 17 Medicare Parts A & B Appeals ProcessMLN006562 May 2021 Print-Friendly VersionMLN BookletMedicare Parts A & B Appeals ProcessMLN006562 May 2021 Page 2 of 17 Table of ContentsWhat s Changed? ..3 Introduction ..4 Appealing Medicare a Representative ..6 Transfer appeal Rights to Non-participating Providers & Suppliers ..6 First appeal Level: MAC Redetermination ..7 Second appeal Level: Qualified Independent Contractor (QIC) Reconsideration ..9 Third appeal Level: Office of Medicare Hearings and Appeals (OMHA) appeal Level: Medicare Appeals Council (Council) Review ..13 Fifth appeal Level: District Court Judicial Review.
This booklet tells health care providers about Medicare’s 5 appeal levels in Fee-for-Service (FFS) (original Medicare) Parts A & B and includes resources on related topics. This booklet doesn’t cover Medicare Parts C or D appeals. It describes how providers, physicians, and suppliers apply the appeals process to their services.
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