Baltimore
CMS has awarded contracts to eight companies to perform
second-level appeals of denied fee-for-service Medicare claims.
Part of an overhaul to the Medicare claims appeals system, to be
completed by Oct. 1, 2005, the reconsiderations that will be
conducted by the eight contractors will replace the current
“fair hearing” process for Part B claims in an effort
to speed the appeals process. Statute requires that
reconsiderations must be completed within 60 days from the day the
request is filed.
Companies awarded these contracts, called Qualified Independent
Contractors (QICs), include Integriguard LLC, Q2 Administrators
(Q2A), Island Peer Review Organization (IPRO), Rivertrust
Solutions, Computer Sciences Corp. (CSC), Maximus LLC, First Coast
Services Options and Permedion.
The contractors will be able to bid on specific types of appeals
workloads, including DME appeals, and in the specific areas of the
country for which they will process claims, CMS stated in a press
release.
Other changes include developing an appeal-specific data system
that allows users to track individual appeals in real time, and
finalizing the transfer of responsibility for third-level appeals,
conducted by Administrative Law Judges (ALJs), from the Social
Security Administration to the Department of Health and Human
Services.
