Medicare Program; Medicare Appeals of Individual Claims
medicare · Centers for Medicare and Medicaid Services · Rule · Published 1997-05-12 · 62 FR 25844
Document
Document number
97-12263
Federal Register citation
62 FR 25844
CFR reference
42 CFR 405
Type
Rule
Action
Final rule with comment period.
Category
medicare
Sub-agency
Centers for Medicare and Medicaid Services
Publication date
1997-05-12
HHS docket
BPD-453-FC
Abstract
Under section 1869 of the Social Security Act, Medicare beneficiaries and, under certain circumstances, providers or suppliers of health care services may appeal adverse determinations regarding claims for benefits under Medicare Part A or Part B. This rule expands our regulations to recognize the right of Part B appellants to a hearing before an administrative law judge (ALJ) for claims if at least $500 remains in dispute and the right to judicial review of an adverse ALJ decision if at least $1,000 remains in controversy. Also, this rule codifies in regulations: Limitations on the review by ALJs and the courts of certain national coverage determinations, and the statutory authority for an expedited appeals process under Part A and Part B.