The 5 levels of Appeals

The 5 levels of Appeals

US Rehab Article  September

Appeals process

Did you know that the ALJ level of appeals are behind greater than 200 days in some areas?

At any level in the appeals process you have the option to ask to escalate your appeal to the next level if there is good cause such as the length of time the ALJ has been reviewing your case of when you ask they tell you it is going to be greater  than an acceptable time frame.

There are not just 3 but ***5*** levels of appeals.

  • Redetermination – by your DMEMAC
  • Reconsideration – QIC (Qualified Independent Contactor)
  • ALJ – Administrative law Judge
  • Review by Medicare Appeals Council
  • Judicial review in U.S. District Court

At each level there instructions sent to you about your next options.

Many feel that the ALJ is the last level but there are two more layers of the appeals process. Not many providers are even familiar with anything above and ALJ – The next level is basically call the Peer Review Council ( Medicare Appeals Council) and you can ask to be escalated to this level if your ALJ is backed up to the point that it may be another 200 days before you get an answer.

Please call us if you have any questions and need any assistance with the appeals process.

Peggy Walker, RN

Director of Reimbursement Services

US Rehab/VGM