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Linda Collins Blogger

Medicare Appeals Process – Level 2: Reconsideration

Posted by Linda Collins | April 21, 2016

If you are dissatisfied with the results of a Medicare level one appeal, redetermination, you request the next level of appeal. The Medicare level 2 appeal is a reconsideration and is managed by a Qualified Independent Contractor (QIC).

You have 180 days from the date of the redetermination to file a request for a reconsideration. The request must be made on standard form CMS-20033 or in writing.

The following information is required in your letter:

  • Beneficiary's name
  • Beneficiary's Medicare health insurance claim (HIC) number
  • Specific service(s) and item(s) for which the reconsideration is requested, and the specific date(s) of service
  • Name and signature of the party or representative of the party
  • Name of the contractor that made the redetermination

The request should clearly explain why you disagree with the redetermination. A copy of the denial letter and any other useful documentation should be sent with the reconsideration request to the appropriate QIC.

As in the initial appeal, take the time to organize your documents, identify each as a specific exhibit, create a table of contents, and a short cover letter justifying the appeal. 

Generally, the QIC will respond within 60 days of receipt of the appeal. If the appeal decision is not favorable, you will be provided with information for filing a hearing with an Administrative Law Judge (ALJ.) This process will be discussed in the next Össur R&R post. 

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