Dollar Amount in Controversy Required to Sustain Appeal Rights
The Centers for Medicare and Medicaid Services has announced the dollar amount that must remain in controversy to sustain appeal rights beginning January 1, 2021. The amount that must remain in controversy for Administrative Law Judge (ALJ) hearing requests filed on or after January 1, 2021, is $180. This is an increase of $10.00 from calendar year 2020.
The amount that must remain in controversy for reviews in Federal District Court requested on or after January 1, 2021, is $1,760. This is an increase of $90.00 from calendar year 2020.
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This article is not intended to and does not serve as legal advice or as consultative services, but is for general information purposes only.
My intake paperwork has a notice to the patient that they have a right to an appeal if an insurer denies coverage for their services. 1)Is this news bulletin stating that their right is only upheld if the dollar amount is greater than $180? 2)Or that they are only entitled to a federal “hearing” if the amount greater than $180? 3)And the different rate of $1,760 is for federal “court”?
Apologies for my ignorance in what is being shared here, but I do wish to better understand, particularly in relation to being a patient advocate.
Thank you for sharing!