Change in the Amount in Controversy Requirement for Administrative Law Judge Hearings and Federal District Court Appeals
MLN Matters Number: MM6295
Related Change Request (CR) #: 6295
Related CR Release Date: January 30, 2009
Effective Date: May 4, 2009
Related CR Transmittal #: R1676CP
Implementation Date: May 4, 2009
Provider Types Affected
Physicians, providers and suppliers submitting claims to Medicare Carriers, Durable Medical Equipment Medicare Administrative Contractors (DME MACs), Fiscal Intermediaries (FIs), Part A/B MACs (A/B MACs), and/or Regional Home Health Intermediaries (RHHIs) for services provided to Medicare beneficiaries
Provider Action Needed
This article is based on Change Request (CR) 6295, which notifies Medicare contractors of the Amount in Controversy (AIC) required to sustain Administrative Law Judge (ALJ) and Federal District Court appeal rights beginning January 1, 2009.
The amount remaining in controversy requirement for ALJ hearing requests made before January 1, 2009, is $120. The amount remaining in controversy requirement for requests made on or after January 1, 2009, is $120.
For Federal District Court review, the amount remaining in controversy goes from $1,180 for requests on or after January 1, 2008, to $1,220 for requests on or after January 1, 2009.
Background
The Medicare claims appeal process was amended by the Medicare, Medicaid, and SCHIP Benefits Improvement and Protection Act of 2000 (BIPA). CR 6295 modifies the Medicare Claims Processing Manual (Publication 100-4, Chapter 29, Section 330.1 and Section 345.1) to update the AIC required for an ALJ hearing or judicial court review.
Additional Information
The official instruction (CR 6295) issued to Palmetto GBA is available at
www.cms.hhs.gov/Transmittals/downloads/R1676CP.pdf (PDF, 105 KB).
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Disclaimer
This article was prepared as a service to the public and is not intended to grant rights or impose obligations. This article may contain references or links to statutes, regulations, or other policy materials. The information provided is only intended to be a general summary. It is not intended to take the place of either the written law or regulations. We encourage readers to review the specific statutes, regulations and other interpretive materials for a full and accurate statement of their contents.