Monday, October 21, 2019

Quality to the Next Level


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FAQs

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Answer: A reconsideration is the second level in the revised Medicare appeals process. An appellant may file a request for reconsideration if he or she is dissatisfied with the results of the Medicare administrative contractor's redetermination.

 

I am a beneficiary and I have a question about my reconsideration. How do I get in touch with someone regarding my appeal?

Answer: If you are a beneficiary, call 1-800-MEDICARE for any questions regarding an appeal. Do not use the Website Help link at Q2A.com. Emails from this link are sent to the Q2A Web site technical support staff. They do not have access to information regarding specific appeals or appeals decisions.

 

What should I include on the reconsideration request?

Answer:

Your written request should include the following information:

    1. The beneficiary's name; Medicare health insurance claim number;
    2. The specific service(s) and item(s) for which the reconsideration is requested and the specific date(s) of service;
    3. The name and signature of the party or representative of the party;
    4. The name of the contractor that made the redetermination

 

How long does the QIC have to make its decision?

Answer: The QIC has 60 days to make a decision. If a QIC can not complete the reconsideration within that time frame, it must offer the appellant the opportunity to escalate the request to an Administrative Law Judge (ALJ) hearing.

 

I need to find out something about my claim right away. If I just e-mail the Website help, can someone look it up and get back to me?

Answer: E-mails from the Website Help link are sent to Q2A Web site technical staff. They do not have access to specific claims or claim information
 

 

 

Do I need to use the standard reconsideration form or can I simply submit the request in writing?

Answer: The standard reconsideration form,CMS Form 20033, includes all information necessary to submit a request. However, use of the form is optional.

 

When I put in the redetermination/fair hearing number, it tells me no match found. What am I doing wrong?

Answer: Cases at other levels of appeal do not have the same appeal number. Q2A handles reconsiderations, the second level in the appeals process. Therefore, you will not find information on our site regarding the status of a redetermination, or fair hearing.

 

How will I know the QIC has received my reconsideration request?

Answer: The QIC has 14 days to acknowledge your reconsideration request. Please allow 14 days to hear back from the QIC.

 

I submitted a reconsideration request and have not heard anything. What should I do?

Answer: If more than 14 days have passed and you have not received a response from a QIC, send a letter to that QIC. Be sure you are writing to the QIC that handles your jurisdiction. To identify the correct QIC and their address view the "Requesting an Appeal" section for Part A appeals and Part B/DME appeals.

 

I’ve received an acknowledgement letter from the QIC. How do I check the status of my reconsideration? Do I need a login to view the status of an appeal?

Answer:

If you are a provider, you may check the status of the reconsideration request by going to the “Providers: Appeal Status Information” section of Q2A.com. Enter the reconsideration Medicare Appeal Number in the search field.

Search results only include the following basic information about an appeal: date received, appeal status, and deadline. Privacy laws prohibit the display of any protected health information (PHI).
 
A Provider does not need a login to view the status of an appeal. All information for providers is located on the public side of the Q2A.com Web site.

 

What happens after I receive a favorable ALJ decision?

Answer:

Favorable rulings by an Administrative Law Judge (ALJ) do not result in immediate payment of claims.

Once an ALJ rules favorably on an appeal, the Office of Medicare Hearings and Appeals (OMHA) forwards the decision and case file to the Administrative Qualified Independent Contractor (AdQIC).
 
The AdQIC subsequently has 10 days to update the appeals tracking system and to decide whether the case requires further review by the Medicare Appeal Council (referred to interchangeably as the Departmental Appeals Board, or DAB) or is sent to the Medicare administrative contractor (MAC) for payment. The AdQIC’s review cannot begin until it receives the case file. Regulations do not require the OMHA to forward case files within a given amount of time.
 
If the AdQIC refers the case to the Medicare Appeals Council, the MAC that processed the original claim is notified. Effectuations (payment of claims) made by the contractor are then contingent upon the Medicare Appeal Council’s decision.
 
For ALJ decisions that require no further review, the AdQIC sends an effectuation notice to the contractor, who must then pay specified claim amounts within 30 days. Effectuations in which the contractor must calculate the amount may take up to 60 days.
 

 

Where can I find my reconsideration appeal number?

Answer:
You will find the reconsideration appeal number in the upper right corner of the acknowledgement letter sent by the QIC handling your case.

 

I am a provider and I have a question about my reconsideration. How do I get in touch with someone regarding my appeal?

Answer:
If you are a provider, you may submit a written inquiry to the QIC that is handling your reconsideration or use the phone number listed on your acknowledgement letter. To find the correct address view the "Requesting an Appeal" section for Part A appeals and Part B/DME appeals.

Providers should use the Appeal Status link on the home page of the Web site to check the status of an appeal. Any specific questions should be addressed in a written inquiry to the Qualified Independent Contractor handling your appeal.

Do not use the Website Help link at Q2A.com. Emails from this link are sent to the Q2A Web site technical support staff. They do not have access to information regarding specific appeals or appeals decisions.

 

What is the purpose of the Website help feature? What questions can I send through the Website help?

Answer:
The Website help feature should ONLY be used to send comments or ask questions about the functionality of the Q2A web site. This includes any questions or comments regarding navigation, site content, or technical issues you may encounter while visiting the site.

 

I submitted an appeal request with a QIC and have received an acknowledgment letter, however I no longer wish to pursue an appeal. Can I retract my request?

Answer:

If you have filed an appeal request with a QIC, but have decided to retract that appeal request, you can do so according to 42 CFR § 405.972.

 

This regulation states that you may file a written and signed request for withdrawal with the appropriate QIC. The contents of this request for withdrawal must include a clear statement that the appellant is withdrawing the request and does not intend to proceed further with the appeal. The request for withdrawal must also be received in the QIC’s mailroom before the reconsideration is issued.

 

How can I contact the Qualified Independent Contractor handling my appeal?

Answer:

Contact information is located on your acknowledgement letter. If you have not received an acknowledgement letter, use the information found on the links below:

Part A Reconsiderations

Part B / DME Reconsiderations

 

 

 

 

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