# Medicare Appeals Process Comparison 

+----------+---------+--------+---------+---------+--------+----------+
| Appeal   | O       |        | BIPA    | Current |        | P        |
| Level    | riginal |        |         | -- SSA  |        | rojected |
|          | -- SSA  |        |         | m       |        | -- BIPA  |
|          |         |        |         | odified |        | modified |
|          |         |        |         | by BIPA |        | by MMA   |
+==========+=========+========+=========+=========+========+==========+
|          | Part A  | Part B | Part A, | Part A  | Part B | Part A,  |
|          |         |        | B       |         |        | B        |
+----------+---------+--------+---------+---------+--------+----------+
| Reconsi  | R       | C      | R       | R       | C      | Redeter  |
| deration | econsid | arrier | edeterm | econsid | arrier | mination |
|          | eration | Review | ination | eration | Review |          |
| Review   |         |        |         |         |        | (FI or   |
|          | (FI)    | (Ca    | (FI or  | (FI)    | (Ca    | Carrier) |
| Redeter  |         | rrier) | C       |         | rrier) |          |
| mination | **TTF** |        | arrier) | **TTF** |        | **TTF**  |
|          | = 60 d  | *      |         | = 120d  | *      | = 120d   |
|          |         | *TTF** | **TTF** |         | *TTF** |          |
|          | **AIC** | = 6 mo | = 120d  | **AIC** | = 120d | **AIC**  |
|          | = \$0   |        |         | = \$0   |        | = \$0    |
|          |         | *      | **AIC** |         | *      |          |
|          | **TLP** | *AIC** | = \$0   | **TLP** | *AIC** | **TLP**  |
|          | = 75% - | = \$0  |         | = 75% - | = \$0  | = 60d    |
|          | 60d;    |        | **TLP** | 60d;    |        |          |
|          | 90% -   | *      | = 30 d  | 90% -   | *      |          |
|          | 90 d    | *TLP** |         | 90 d    | *TLP** |          |
|          |         | = 95%  |         |         | = 95%  |          |
|          |         | in 45d |         |         | in 45d |          |
+----------+---------+--------+---------+---------+--------+----------+
| Carrier  |         | C      | R       |         | C      | Reconsi  |
| Hearing  |         | arrier | econsid |         | arrier | deration |
|          |         | H      | eration |         | H      |          |
| Reconsi  |         | earing |         |         | earing | (QIC)    |
| deration |         |        | (QIC)   |         |        |          |
|          |         | (Ca    |         |         | (Ca    | **TTF**  |
|          |         | rrier) | **TTF** |         | rrier) | = 180d   |
|          |         |        | = 180d  |         |        |          |
|          |         | *      |         |         | *      | **AIC**  |
|          |         | *TTF** | **AIC** |         | *TTF** | = \$0    |
|          |         | = 6 mo | = not   |         | = 6 mo |          |
|          |         |        | sp      |         |        | **TLP**  |
|          |         | *      | ecified |         | *      | = 60d    |
|          |         | *AIC** |         |         | *AIC** |          |
|          |         | =      | **TLP** |         | =      |          |
|          |         | \$100  | = 30d   |         | \$100  |          |
|          |         |        |         |         |        |          |
|          |         | *      |         |         | *      |          |
|          |         | *TLP** |         |         | *TLP** |          |
|          |         | =      |         |         | =      |          |
|          |         | 90% -  |         |         | 90% -  |          |
|          |         | 120d   |         |         | 120d   |          |
+----------+---------+--------+---------+---------+--------+----------+
| Admini   | ALJ     | ALJ    | ALJ     | ALJ     | ALJ    | ALJ      |
| strative |         |        |         |         |        |          |
| Law      | **TTF** | *      | **TTF** | **TTF** | *      | **TTF**  |
| Judge    | = 60d   | *TTF** | = DHHS  | = 60d   | *TTF** | = 60d    |
| (ALJ)    |         | = 60d  | dis     |         | = 60d  |          |
|          | **AIC** |        | cretion | **AIC** |        | ^1       |
|          | = \$100 | *      |         | = \$100 | *      | ^**AIC** |
|          |         | *AIC** | **AIC** |         | *AIC** | = \$100  |
|          | **TLP** | =      | = \$100 | **TLP** | =      |          |
|          | = none  | \$100  |         | = none  | \$100  | **TLP**  |
|          |         | home   | **TLP** |         |        | = 90d    |
|          |         | h      | = 90d   |         | *      |          |
|          |         | ealth; |         |         | *TLP** |          |
|          |         | \$500  |         |         | = none |          |
|          |         | all    |         |         |        |          |
|          |         | else   |         |         |        |          |
|          |         |        |         |         |        |          |
|          |         | *      |         |         |        |          |
|          |         | *TLP** |         |         |        |          |
|          |         | = none |         |         |        |          |
+----------+---------+--------+---------+---------+--------+----------+
| Depa     | DAB     | DAB    | DAB     | DAB     | DAB    | DAB      |
| rtmental |         |        |         |         |        |          |
| Appeals  | **TTF** | *      | **TTF** | **TTF** | *      | **TTF**  |
| Board    | = 60d   | *TTF** | = DHHS  | = 60d   | *TTF** | = 60d    |
| (DAB)    |         | = 60d  | dis     |         | = 60d  |          |
|          | **AIC** |        | cretion | **AIC** |        | **AIC**  |
|          | = \$0   | *      |         | = \$0   | AIC =  | = \$0    |
|          |         | *AIC** | **AIC** |         | \$0    |          |
|          | **TLP** | = \$0  | = \$0   | **TLP** |        | **TLP**  |
|          | = none  |        |         | = none  | *      | = 90d    |
|          |         | *      | **TLP** |         | *TLP** |          |
|          | (may    | *TLP** | = 90d   | (may    | = none |          |
|          | d       | = none |         | d       |        |          |
|          | ecline) |        |         | ecline) | (may   |          |
|          |         | (may   |         |         | de     |          |
|          |         | de     |         |         | cline) |          |
|          |         | cline) |         |         |        |          |
+----------+---------+--------+---------+---------+--------+----------+
| Federal  | FDC     | FDC    | FDC     | FDC     | FDC    | FDC      |
| District |         |        |         |         |        |          |
| Court    | **TTF** | *      | **TTF** | **TTF** | *      | **TTF**  |
| (FDC)    | = 60d   | *TTF** | = 60d   | = 60    | *TTF** | = 60     |
|          |         | = 60d  |         |         | = 60   |          |
|          | **AIC** |        | **AIC** | **AIC** |        | ^1       |
|          | =       | *      | =       | =       | *      | ^**AIC** |
|          | \$1000  | *AIC** | \$1000  | \$1000  | *AIC** | = \$1050 |
|          |         | =      |         |         | =      |          |
|          | **TLP** | \$1000 | **TLP** | **TLP** | \$1000 | **TLP**  |
|          | = none  |        | = none  | = none  |        | = none   |
|          |         | *      |         |         | *      |          |
|          |         | *TLP** |         |         | *TLP** |          |
|          |         | = none |         |         | = none |          |
+----------+---------+--------+---------+---------+--------+----------+
|          | **TTF** |        |         |         |        |          |
|          | = Time  |        |         |         |        |          |
|          | to      |        |         |         |        |          |
|          | file;   |        |         |         |        |          |
|          | **AIC** |        |         |         |        |          |
|          | =       |        |         |         |        |          |
|          | Minimum |        |         |         |        |          |
|          | Amount  |        |         |         |        |          |
|          | in      |        |         |         |        |          |
|          | contr   |        |         |         |        |          |
|          | oversy; |        |         |         |        |          |
|          | **TLP** |        |         |         |        |          |
|          | = Time  |        |         |         |        |          |
|          | limit   |        |         |         |        |          |
|          | for     |        |         |         |        |          |
|          | pro     |        |         |         |        |          |
|          | cessing |        |         |         |        |          |
|          | of      |        |         |         |        |          |
|          | appeal  |        |         |         |        |          |
+----------+---------+--------+---------+---------+--------+----------+

**Table Notes**

1\. In 2005, the AIC requirement for an ALJ hearing and Federal District
Court will be adjusted in accordance with the medical care component of
the consumer price index.