Question

The Medicare fee-for-service appeal process for both beneficiaries and providers typically includes all of the following levels EXCEPT:

a) Level 1: Redetermination by a Medicare Administrative Contractor (MAC)
b) Level 2: Reconsideration by a Qualified Independent Contractor (QIC)
c) Level 3: Hearing before an Administrative Law Judge (ALJ)
d) Level 4: Review by the Centers for Medicare & Medicaid Services (CMS) Board of Appeals

Answer 1

The Medicare fee-for-service appeal process includes three levels: Redetermination, Reconsideration, and a Hearing before an Administrative Law Judge. Review by the Centers for Medicare & Medicaid Services (CMS) Board of Appeals is not part of the appeal process.

Step-by-step explanation:

The Medicare fee-for-service appeal process for both beneficiaries and providers typically includes three levels:

1. Level 1: Redetermination by a Medicare Administrative Contractor (MAC)
2. Level 2: Reconsideration by a Qualified Independent Contractor (QIC)
3. Level 3: Hearing before an Administrative Law Judge (ALJ)

Level 4, which is not part of the appeal process, involves a Review by the Centers for Medicare & Medicaid Services (CMS) Board of Appeals.