CMS eliminates signature requirements for appeal requests

CMS finalized a rule on May 7 aimed at streamlining the Medicare appeals process by removing the signature requirement for appeal requests of Parts A and B claims and Part D prescription drug coverage determinations.

As specified in the Social Security Act, under Medicare Parts A, B, and D, affected parties have the right to appeal a coverage or payment determination through four levels of administrative review. Previously, a redetermination form for these claim types had to contain a signature from the appellant (i.e., person or entity filing the appeal), unless it was submitted at the Office of Medicare Hearings and Appeals (OMHA) level.

The final rule comes after the release of court documents which show that Medicare had a backlog of 426,594 appeals in fiscal year 2018. The regulatory changes are part of a larger CMS initiative aimed at reducing burden on appellants and promoting consistency between appeal levels.

In its rule, CMS also finalized the following changes to the appeal process for Medicare Parts A and B claims and Part D prescription drug coverage determinations:

• New guidance to account for situations when the overpayment amount specified in a demand letter does not reflect subsequent adjustments. According to the rule, if an appeal involves an identified overpayment, the amount in controversy (AIC) is the amount specified in the demand letter. However, if the amount originally demanded changes as a result of a subsequent determination or appeal, the AIC is the amount of the revised overpayment. 
• The new timeframe for CMS or its contractors to refer a case to the Medicare Appeals Council is 60 days after receiving the written decision or dismissal. Previously, the timeframe was 60 days after the date of the decision or dismissal by the OMHA. According to CMS, this will help ensure that CMS and its contractors have enough time to decide whether the case should be referred to the Medicare Appeals Council for review.
• The new timeframe for vacating dismissals is six months rather than 180 days after the date of the notice of dismissal. Medicare adjudicators have more time to vacate (set aside) a dismissal of an appeal request for a Part A or B claim or Part D coverage determination.

These regulations are effective July 8 (60 days after the rule’s publication in the Federal Register).