The patient needs to submit the CMS-20027 form within 120 days of the initial determination. The re-determination division then has 60 days to respond to the request.
The CMS-20033 need to be submitted within 180 days of the re-determination decision. The Qualified Independent Contractor has 60 days to make a decision. The patients can request 14-day extensions each time they submit new documentation in support of their appeal.
Medicare decisions can be reviewed by an Administrative Law Judge (ALJ). By this point, the claim must be for a minimum of $120 and the patient has 60 days to submit the appeal. From the point, the ALJ has 90 days to submit a decision. If, however, there is no decision from a Qualified Independent Contract, then the ALJ can take up to 180 days. Since there are only 4 offices nationwide, the vast majority of disputes are heard via teleconference or over the telephone.
Again, the Medicare recipient has 60 days to submit an appeal and the Council has 90 days to review all the documents and provide a decision.
This final step is the most drastic of the appeal processes and the claim must be at least $1,220. The claim must be submitted within 60 days of the Medicare Appeals Council decision.
As this can be a laborious and time-intensive process, it is recommended that any Medicare recipient making an appeal should seek out legal advice once they reach Level 3. If they proceeded, they should also have a lawyer for Stages 4 and 5 as well.