Sunday, June 6, 2010

4) Medicare Appeals Council (MAC) - Medicare 4the level appeal

In this level, the appellant has 60 days to file an appeal, delineating specific  reasons for contending with the ALJ’s decision. The appealing party can also escalate the case to a MAC if the ALJ is unable to make a decision in 90 days. In this case, the appellant must file the request for escalation to both the ALJ
and the MAC. If this occurs, the MAC will review the case de novo (meaning the MAC will examine all issues and not just those appealed). The appellant will not have a right to a hearing by the MAC, which will review all the information in the administrative records and either reverse, adopt, modify the ALJ’s decision, or remand the case to the ALJ for further proceedings. There are no requirements for the AIC. If the MAC deems a negative decision, the appellant

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