Administrative Law Judge hearing - Medicare 3rd level appeal

The appealing party has 60 days from receipt of the paper work from the QIC to file an appeal. ALJ hearings may be conducted in person, video teleconference (VTC), or by telephone. Multiple appellants can unite to meet the AIC requirements for an ALJ if the claims were previously reconsidered by a QIC. A request for an ALJ hearing must be made in writing (you can use the standard CMS 20034 A/B form). If you do not use this form, you must send patient identifying information (same as earlier levels); the reason the appellant disagrees with the QIC’s reconsideration, and a statement of any additional evidence to be submitted.

The ALJ will send a notice providing details on the hearing and informing the appellants of their right to waive the hearing. If you have written evidence to submit to the ALJ, you will need to submit it within 10 days of receiving the notice of hearing; later submission may extend the time for the ALJ’s decision. Under certain extenuating circumstances (for example, if the appellant does not have a VTC), the ALJ can grant an in-person hearing. The office of Medicare Hearing and Appeals will make a coverage decision in 90 days. If the ALJ’s decision is unfavorable to the appellant, he or she can file another request

Posted in: Medicare appeal