- RuralServ
- CMS FQHC and RHC Flexibilities to Fight COVID-19 Update
- Original Medicare First Level of Appeal Tips Sheet for Medicare Providers
- Ambulance Rural ZIP Code Search
- CMS Rural Health Resources
- CMS Rural Health Clinics Center
- Coverage of Rural Air Ambulance Services
- FISS/DDE Provider Online Guide: Chapter IV - ZIP Code File (19)
- Fundamentals of Medicare: Skilled Nursing Facility Inpatient Care
- Answers to Common Fee-For-Time Compensation Arrangements Questions
- Federally Qualified Health Center Payment Limits
- Hospice Payment Rates
- Medicare Coverage at Federally Qualified Health Centers for Primary Health Care Services for Medicare Patients
- Medicare Coverage at Rural Health Clinics for Primary Health Care Services for Medicare Patients
- Health Professional Shortage Area
- Maximum Payment Limits for Rural Health Centers
- Medicare Learning Network Articles, Medicare Monthly Review
- Prepare and Submit a Cost Report
- Safer Use of Opioid Pain Medication for Medicare Patients
- New York State Ambulance Services in Rural Areas
- Prepare and Submit an MSP Conditional Claim
- Telehealth Services
- Submit Supporting Documentation
Original Medicare First Level of Appeal Tips Sheet for Medicare Providers
If you disagree with Medicare’s claim determination, you may appeal. However, please follow these important tips before you submit a first level of appeal (redetermination) with your MAC, National Government Services.
Appeal Tips
Submit all redetermination requests on time in writing or via electronic portal (NGSConnex) within 120 days of the claim determination date.
- NGSConnex is the quickest and easiest option to submit a first level appeal.
- You may choose to use the CMS Redetermination Form and mail with appropriate supporting documentation.
- Processing time for level one appeals is 60 days; within that timeframe, please do not send or submit via NGSConnex another appeals request to avoid duplicates.
- Include a POC from within your facility or agency with all appeals; including name, telephone number, and office hours.
- Verify the denial message on the RA has appeal rights before submitting a request.
- Include only relevant supporting documents with your request that was not provided for the initial claim determination.
- Include a copy of the demand letter(s) if you are appealing an overpayment determination.
- Include a copy of the Appointment of Representative form if an individual from outside your facility or agency is representing the appellant.
- If the appeal involves an overpayment determined through sampling and extrapolation, identify all contested sample claims in one appeal request and clearly state any sampling methodology challenges.
Related Content
- MLN® Booklet: Medicare Parts A & B Appeals Process
- MLN® Fact Sheet: Medicare Overpayments
- Providers Using NGSConnex to Submit Appeals and Supporting Documentation
Revised 9/21/2023