The First Level of the Medicare Appeals Process, 2008-2012: Volume, Outcomes, and Timeliness

HHS: 10-02-2013

 

Summary

WHY WE DID THIS STUDY

The Medicare appeals process serves as an important protection for beneficiaries and providers. This study represents OIG’s first examination of redetermination, i.e., the first level of the appeals process for Medicare Parts A and B. Medicare refers to the process for the first level of appeals as redetermination. This study contributes to OIG’s body of work concerning the Medicare appeals system.

HOW WE DID THIS STUDY

This study focused on redeterminations processed for Medicare Parts A and B during 2008-2012. We obtained and analyzed data on redeterminations and claims processed from CMS’s Contractor Reporting of Operational and Workload Data system for calendar years 2008-2012. We surveyed 18 contractors that process redeterminations for Medicare Parts A and B and interviewed 5 of them to learn more about how they process redeterminations. Read more