Question

If a Medicare claim is not paid the first step in the appeals process is to write a letter of appeal. If the original decision is upheld, which one of the below is the next step?

a. Submit a request for a hearing before an administrative law judge
b. Appeal to the Medicare Appeals Council
c. No further action can be taken
d. Request a reconsideration by a Qualified Independent Contractor

Answer 1

If the original decision is upheld after writing a letter of appeal for a Medicare claim that was not paid, the next step in the appeals process is to request a reconsideration by a Qualified Independent Contractor.

Step-by-step explanation:

If the original decision is upheld after writing a letter of appeal for a Medicare claim that was not paid, the next step in the appeals process is to request a reconsideration by a Qualified Independent Contractor. This involves submitting a written request to a Qualified Independent Contractor (QIC) who will review the claim and make a decision. If the QIC upholds the original decision, there are further steps that can be taken in the appeals process.