-
Posting Date: 12/02/2024
The CY 2025 Medicare Physician Fee Schedule Is Now Available
The CY 2025 Medicare Physician Fee Schedule Is Now Available The CY 2025 MPFS is now available. You can view the new fees using the Fee Schedule Lookup tool page on NGSMedicare.com. Posted 12/2/2024
Read More -
Posting Date: 11/20/2024
Start Your Morning with a Podcast - Navigating Medicare: Part A Insights for Providers
Start Your Morning with a Podcast - Navigating Medicare: Part A Insights for Providers Did you know we have a podcast channel on both Spotify and Apple Podcasts that are just for our providers? On your way to work each day, listen to these [...]
Read More -
Posting Date: 11/21/2024
All Part B Providers – Register Now!
All Part B Providers – Register Now! Don't miss your chance to attend! Don't miss your chance to attend the National Government Services Medicare Part B 2024 Preventive Services Virtual Conference! Registration is happening now, and seats are [...]
Read More -
Posting Date: 02/24/2022
Request a Redetermination
Request a Redetermination The first level of appeal is carried out by the affiliated contractor/MAC. Time limit to initiate = 120 days from date of receipt of the initial determination notice Time limit to complete the review = 60 days [...]
Read More -
Posting Date: 06/30/2021
Submit a Reconsideration
Submit a Reconsideration The second level of appeal is the reconsideration request and is carried out by the QIC. Time limit to initiate = 180 days from date of receipt of redetermination decision Time limit to complete the review = 60 [...]
Read More -
Posting Date: 06/30/2021
Medicare Appeals Council Review
Medicare Appeals Council Review The fourth level of appeal is carried out by the MAC; this may also be referred to as the Department Appeals Board or DAB. Time limit to initiate = 60 days from date of receipt of ALJ decision Time limit to [...]
Read More -
Posting Date: 01/04/2021
Reopenings for Minor Errors and Omissions
Reopenings for Minor Errors and Omissions Providers may request a reopening of the original claims processing decision by contacting the TRU. The TRU can be used when you wish to revise the initial determination of a specific service or [...]
Read More -
Posting Date: 12/20/2016
Reopening Request Timeframes
Reopening Request Timeframes According to the CMS IOM Publication 100-04, Medicare Claims Processing Manual, Chapter 34, Section 10.6.2, Timeframes for Party Requested Reopenings: A party may request a contractor reopen and revise its initial [...]
Read More -
Posting Date: 10/06/2022
ALJ Hearing
ALJ Hearing The third level of appeal is an ALJ hearing. Time limit to initiate = 60 days from the date of receipt of reconsideration (QIC decision) Time limit to complete the review = 90 days Amount in controversy = The amount that must [...]
Read More -
Posting Date: 01/18/2022
Federal Court Review
Federal Court Review The fifth level of appeal is carried out by the Federal District Court (U.S. District Court). Time limit to initiate = 60 days from date of receipt of Medicare Appeals Council decision Amount in Controversy = The [...]
Read More