CHA News Article

CMS Requires MACs to Defend Medical Review Decisions Through ALJ Appeals

Beginning Oct. 27, the Centers for Medicare & Medicaid Services will require Medicare Administrative Contractors (MACs) and other contractors to support their medical review decisions through the Administrative Law Judge (ALJ) level of appeal. Prior to the attached transmittal, participation by MACs at this stage of the appeal process was voluntary. The transmittal requires the MAC to assign a physician to participate or take “party status” at ALJ hearings, and to oversee the ALJ hearing support process established in the corresponding section of the transmittal. Any physician overseeing or taking party or participant status should be a current certified medical director or MAC-employed. CHA reminds members that the Office of Medicare Hearings and Appeals will host the second Medicare Appellant Forum Oct. 29.

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