Posts Tagged ‘Medicare claims process’

Michael J. Astrue, Commissioner of Social Security, today announced that the agency’s first Extended Service Team (EST) is open for business in Little Rock, Arkansas. The Little Rock EST will make disability decisions for state Disability Determinations Services (DDSs) that are most adversely affected by the flood of new initial disability claims resulting from the economic downturn and from counterproductive furloughs of employees at the state level. Later this year, Social Security will open additional ESTs in Madison, Mississippi; Roanoke, Virginia; and Oklahoma City, Oklahoma. The ESTs are in states that have a history of high quality and productivity, as well as the capacity to hire and train significant numbers of additional employees.

“The strategy behind ESTs builds on our success with National Hearing Centers, where cases are handled electronically from all over the country,” Commissioner Astrue said. “These centralized units have reduced the hearings backlog and improved processing times at some of the hardest-hit hearing offices. This approach clearly works and extending it in this way can help us meet the challenge of unprecedented growth in our disability workloads.”

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Once an initial claim determination is made, beneficiaries, providers, and suppliers have the right to appeal Medicare coverage and payment decisions. There are five levels in the Medicare Part A and Part B appeals process. The levels are:

First Level of Appeal:    Redetermination by a Medicare carrier, fiscal intermediary (FI), or Medicare Administrative Contractor (MAC).

Second Level of Appeal: Reconsideration by a Qualified Independent Contractor (QIC)

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