Posted on Thursday, April 18, 2019 8:12 PM
CMS has issued Change Request 11042, which will update the Medicare Claims Processing Model, Chapter 29 – Appeal of Claim Decisions.
The updates address: acceptable signatures, limiting the scope of redetermination review in specific cases, application of good cause for filing late and application of good cause when there is a declared disaster.
Following are key revisions CMS has incorporated into the manual:
- Adds the terms Medicare number, Medicare Beneficiary Identifier (MBI), and attorney adjudicator to the Glossary.
- Includes throughout the chapter of the Medicare number which incorporates both the Health Insurance Claim Number (HICN) and the new MBI.
- Requires the Medicare Administrative Contractors (MACs) to document good cause for late filing on the appeal decision letter or the appeal case file.
- Instructs the MACs on procedures to follow for appeals when a natural or man-made disaster occurs.
- Outlines policies for accepted forms of signatures.
- Requires the MACs to toll the timeframe when attempting to cure a defective appointment instrument.
- Provides guidance for the MACs in determining proper parties to an appeal when a beneficiary is incapacitated or in the case of a beneficiary’s death.
- Updates policies for redeterminations
Source: NAHC Report
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