New Appeals Timeliness Tool

on Thursday, 28 October 2010. All News Items

Cahaba GBA, the Jurisdiction 10 Medicare Administrative Contractor (MAC) for Alabama, Georgia and Tennessee has a new tool on their web site to help hospitals keep up with the date appeals requests must be received at each level of appeal to meet timeliness guidelines.  Cahaba notes that “CMS Appeals timeliness is the same for both Part A and Part B providers.” 

The Tool instructs you to pick the level of appeal and enter the appropriate date as described below.

Redetermination (1st Level) - date of receipt of the initial determination
Reconsideration (2nd Level) - date of the notice of redetermination letter
Administrative Law Judge Hearing (3rd Level) - date of the Qualified Independent Contractor (QICs) reconsideration notice
Appeals Council Review (4th Level) - date of the Administrative Law Judge (ALJ) decision notice
Judicial Review in U.S. District Court (5th Level) - date of the Department of Appeals Board (DAB) decision notice.

At each Level of Appeal once you have entered the correct date you will click on “find deadline” and the Tool will calculate the date the appeal is due. 

The Tool also has a reminder that if a deadline date falls on a Saturday, Sunday or holiday, the appeal request must be received the previous work day.

To access Cahaba’s new tool go to: http://www.cahabagba.com/part_b/claims/calc.htm.

Further information regarding the appeals process can be accessed at
http://www.cms.hhs.gov/OrgMedFFSAppeals/01_Overview.asp#TopOfPage
www.cms.hhs.gov/MLNProducts/downloads/MedicareAppealsprocess.pdf

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