Medicare beneficiaries will have an additional route to appeal Medicare coverage decisions under a final rule that CMS released this afternoon.
Beneficiaries already have the right to appeal individual claims denials, but the new rule will give them "an additional avenue to challenge the underlying coverage policy," CMS says in a release.
"The new appeals process will ensure that complaints are reviewed in a predictable, uniform manner," the release continues. "Decisions in these appeals may also have implications for future Medicare coverage of the item or service for all Medicare beneficiaries, not just the individual who filed the appeal."
Under the final rule, appeals of local coverage determinations initially will be reviewed by an administrative law judge (ALJ), CMS says. Appeals of national coverage determinations and ALJ decisions would be reviewed by the HHS appeals board, and the board's decisions could be appealed to federal court, the agency adds.
The final rule completes the CMS rulemaking process which began in August 2002 and will be published in the Nov. 7 Federal Register, CMS says. The rule will become effective 30 days after publication, according to a CMS spokesperson.