1
Center for Medicare and Medicaid Services Center for Medicare and Medicaid Services Shelia Turner
May 30th 2017 © 2017 Corning Incorporated. All Rights Reserved. 2
Center for Medicare and Medicaid Services There are various reasons in which one may want to appeal a Medicare
claim for instance Denials for medical care services, prescriptions if
Medicare determines it wasn’t medically necessary and denies payment of
claim, Medicare determines that wheelchair isn’t medically necessary for
one’s condition. The procedure is that you first file your appeal within 120
days after receiving Medicare Summary Notice that lists denied claim then
you circle item on your MSN which you are appealing and clearly explain
why you think the Medicare’s decision is wrong and you may include any
additional information which support the appeal. You then carefully read
specific instructions which appear on MSN about how to file the appeal
and finally sign your name and include your telephone number. Finally you
send the form to Medicare services (Casto et al, 2013)
There are various steps of appealing with redetermination being the initial
process where the center of Medicaid cervices is the one listening to the
appeal. If the appeal is not solved reconsideration level is followed which
is done by independent review organization who will assess the appeal.
The third level is normally before administrative law judge and one may
want to be represented by attorney. This step takes place in a conference
room where witnesses are called and evidence presented. If appeal is
denied at this third level, it may still be presented to Medicare Appeals
Council, a department within U.S. Department of Health and Human
Services. The final appeal level is to the federal courts. One generally has
60 days to file appeals before ALJ, the Medicare Appeals Council and also
to federal court. (La Tour et al, 2013)
© 2017 Corning Incorporated. All Rights Reserved. 3
Center for Medicare and Medicaid Services
One of the advantages of center of Medicare and Medicaid services
website to the public is Access to Info in that the public can actually track
everything that is happening on this institution. The public can visit at any
time of the day or even night and find any information regarding the
health care issues instead of going to the facility offices because it is more
accessible hence it saves time. The center of Medicaid service may upload
something and the public easily find this information. Another advantage
is Satisfaction in that the website is more convenient for the public as it
makes it easy for them to ask or inquire something rather than driving a
car to the physical location and browsing for the location. The public can
just find what they are looking for on the institution online site (CSM,
2017)
The number of menu options on the website is quite a lot and this
becomes complex and confusing to the public. The recommended menu
options is 7 as this becomes simple for the users to adapt but the more
the menu options the more it becomes difficult for the users to make
decisions since the more choices a person has the longer it takes them to
make a decision. Additionally the website has a lot of Drop down menus
which at a glance it seems like a good idea as it saves on space and allow
you to add more information. But most times, drop down menus produce
added complexity to the website and bring confusion on the users
Reference
1. Medicaid & CHIP January 2017 Application, Eligibility, and Enrollment
Data Apr 26, 2017 © 2017 Corning Incorporated. All Rights Reserved. 4
Center for Medicare and Medicaid Services
2. Casto, A.B, &Layman, E.2013.principles of health care reimbursement
(4th edition).Chicago.AHIMA
3. La Tour, K.M Eichenwald, maki, S. (2013).Health information
management; concepts, principles and practices (4th
edition).Chicago.AHIMA © 2017 Corning Incorporated. All Rights Reserved.

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