Question

Mrs. Duarte is enrolled in Original Medicare Parts A and B. She has recently reviewed her Medicare Summary Notice (MSN) and disagrees with a determination that partially denied one of her claims for services. What advice would you give her?

1) Mrs. Duarte should request a reconsideration of the decision by a qualified independent party within 60 days of the date she received the MSN in the mail.
2) Mrs. Duarte has no right to appeal this determination since her claim has been partially paid.
3) Mrs. Duarte should file an appeal of this initial determination within 90 days of the date she received the MSN in the mail. If she still disagrees with Medicare Administrative Contractor's (MAC's) further decision she should request a reconsideration by a qualified independent party within 10 days.
4) Mrs. Duarte should file an appeal of this initial determination within 120 days of the date she received the MSN in the mail.

Answer 1

Mrs. Duarte should appeal the Medicare determination by filing an appeal within 120 days of receiving her MSN, and if necessary, ask for an independent review after the MAC's decision.

Step-by-step explanation:

Mrs. Duarte should request a reconsideration of the decision by a qualified independent party within 60 days of the date she received the MSN in the mail. If Mrs. Duarte disagrees with a determination on her Medicare claim as indicated on her Medicare Summary Notice (MSN), she has the right to appeal. The correct course of action would be to file an appeal of this initial determination within 120 days of the date she received the MSN in the mail. According to Medicare guidelines, an appeal must be filed within this timeframe to request a reconsideration by her Medicare Administrative Contractor (MAC). If after the MAC's decision she still disagrees, she can then request an independent reconsideration.