Process appeals without a ppointment of representation forms. In addition, MA plans may extend the time they have to make a decision on an appeal (excluding appeals for Part B drugs) by up to 14 calendar days if: the beneficiary requests the extension it is justified and in the beneficiary’s interest due to the need for additional medical evidence from a noncontract provider that may change an MA organization’s decision to deny an item or service or, the extension is justified due to extraordinary, exigent, or other non-routine circumstances and is in the beneficiary’s interest.Waiving the timeliness requirement would give the beneficiary more time to obtain the requested documents from their provider. For example, typically, they may ask the appealing beneficiary to send in additional medical documents within a certain time frame, such as 15 days. The same entities may also waive the requirements for timeliness when they request additional information, usually from the person who is appealing. CMS has not yet outlined how this process would work during the emergency periods, but an extension is typically obtained by a beneficiary attaching a letter to their appeal explaining why they could not meet the deadline and requesting additional time. Grant an extension to file an appeal. CMS is allowing Medicare Administrative Contractors and Qualified Independent Contractors in Original Medicare, MA, and Part D plans, as well as the Part C and Part D Independent Review Entity to allow extensions to file an appeal. CMS guidance allows, but does not require, adjudicators to: Notably, these flexibilities are optional.
The temporary changes give the entities hearing or processing a beneficiary’s appeal the authority to remove barriers that might otherwise prevent a beneficiary from successfully filing or pursuing an appeal. People with Medicare who are denied coverage for a health service or item by Original Medicare, Medicare Advantage (MA), or their Part D plan may appeal-or formally request a review of-that decision.ĭuring the coronavirus public health emergency, the Centers for Medicare & Medicaid Services (CMS) is allowing new flexibilities in how these appeals are managed. This Open Enrollment Season Has Cost-Saving Changes for Both Medicare and ACA Plans.New Kaiser Family Foundation Resource Provides Overview of Part D Benefit.Issue Brief Outlines How and Why People with Medicare Choose Between Coverage Options.New Research Shows Need for Better Insulin Access Beyond Medicare.CMS to Release Audit Findings on Overpayments to Medicare Advantage Plans.
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