(Medicare Claims Processing Manual)

2. Missi ng Appointment When Provider or P hysician, Other Suppl ier, or No nbeneficiary is the Represented Party   As ex plain ed in 270.1.6 .B.2 above , if the  individual la cks the authority to a ct on be half of the  party  and is not e ntitle d to obtain or r eceive any information r elated to the  appeal, do not ma ke a good c ause determination; follow  the instru ctions in 270.1.6.B.2. above .  270.1.7 - Incapacitation or Death of Beneficiary (Rev. 4278, Issued: 04- 12-19, Effective: 06 -13-19, Implementation: 06- 13-19)  If at any time after the execution of  a valid appoint ment or nondur able power of attorney the b eneficiary becomes incapacita ted and is una ble to m anage his/h er affairs, the  appointm ent becom es inva lid.  The  MAC  shall resolve  who has legal author ity to act on be half of the beneficiary before disclosing any further information pur suant to the  appointm ent or nondu rable pow er of attorney.  If the beneficiary has executed a durable pow er of attorney that author izes the designated person to c onduc t the beneficiarys affairs, or to m ake financial decisions on be half of the beneficiary, the representation doe s not become  inva lid upon the  beneficiarys sub sequent incapacitation.  NOTE:  Some dura ble pow ers of attorney do not  become  effective until a nd unl ess su ch an incapacit ation occurs.  The death of  a party terminates the author ity of the appoint ed representative.  How ever, if an appeal is in progress and anothe r individua l or entity may be entitle d to re ceive  or obligated to m ake payment for the items or  services th at are the subj ect of  the appeal, t he appointm ent remains in effect for the dura tion of  the appeal.  S ee also, 270.3 f or MSP specific limita tions or a dditiona l requirements.  If the beneficiary is deceased, the  legal representative of the estate may file an app eal.  In the a bsence of a legal representative, any person who has assum ed responsibili ty for settling  the d ecedents estate may file the appeal.  In the se situations, the  MAC  shall obt ain proof that the person ha s assum ed responsibili ty for settling the  deced ents estate (e.g., a will or  probate court doc ument).  What is accept able as legal documentation m ay vary according to State law.  The  MAC  shall notif y the person f iling the appeal a bout the documentation neede d to s how the  person is e ither the legal representative of the estate or the person who has assum ed re sponsibili ty for settling the  dece dent's estate and describe the types of documentation neede d.  Allow a t least 14 cal endar days for the documentation to be  submitt ed.  If, at the end of  the time allowed, the  documentation neede d is not submitt ed, dismiss the  request.  If the appellant submits the  documentation af ter the allotte d tim e, the MAC c onsid ers good c ause for late filing.  In suc h inst ances, the MAC  documents the file to show the  basis for that persons filing the appeal.  MACs shall follow state law when determining proper parties to initial determinations and appeals. Legal representatives of deceased beneficiaries can be proper parties to initial determinations and appeals.  In order to verify that the requester is the pr oper representative, MACs shall be aware of the current state laws in their jurisdictions and shall accept any documentation acceptable by the appropriate state.  The documentation must be sufficient to verify that the individual making the request is a pr oper and valid representative for purposes of initial determinations and appeals under 42 CFR Part 405.  Examples of proper documentation based on state law include, but are not necessarily limited to:    Probate court documents (such as, letters of administration or letters of testamentary to an executor named in the deceased beneficiarys will).    The deceased beneficiarys will naming the executor.    Appointment of Representative document (CMS -1696 form or other similar document).    An instrument executed by a beneficiary that confers representative authority in accordance with state law (for example, health care proxy appointment, Power of Attorney form, or Durable Power of Attorney form).    Representative appointment made by a court of law on behalf of a deceased beneficiary that has not named an executor to handle his or her estate.    Examples of insufficient documentation include:   Claims against the decedents estate without an authorized representative listed.    Any unsigned writing conferring authority on the party to act as a legal representative.    The beneficiarys certificate of death.   270.1.8 - Disclosure of Individually Identifiable Beneficiary Information to an Appointed Representative (Rev. 2729, Issued: 06 -21-13, Effective: 07-23-13, Implementation: 07- 23-13)  In accordance with the  provisions of  the Privacy Act, bef ore the MAC  may release beneficiary-specific information to a n appoint ed representative, the beneficiary or appellant must c ompl ete and sign CMS-1696, or othe r conforming  written inst rument, na ming  that individua l as his/h er representative.  The MAC  shall use caution in re leasing beneficiary-specific information to appoint ed representatives.  The  representative is entitle d to r eceive  only information th at the party (beneficiary or appellant) would be  entitle d to r eceive  (e.g., the de termination l etter) and that whi ch is p ertinent to the  case/claim for which the representative is being a ppoint ed.  For more information a bout the  disclosur e of identifiable information a bout b eneficiaries, see the M edicare General Information, Eli gibilit y, and Ent itlement M anual, Chapter 6: see also 300 be low.  270.2 - Assignment of Appeal Rights  (Rev. 2729, Issued: 06 -21-13, Effective: 07 -23-13, Implementation: 07-23 -13)  270.2.1 - Assignment of Appeal Rights - Introduction  (Rev. 1274, Issued: 06- 29-07, Effective: 07 -01-07, Implementation: 10- 01-07)  A beneficiary may assign his or her appeal rights to a provider or supplier who furnished an item or service to the beneficiary that is at issue in an appeal.  Only providers or suppliers who are not a party to the initial determination may accept assignme nt of appeal rights from a beneficiary (See 210 for information on who is a party to an appeal.)   Because beneficiaries have difficulty understanding the term assignment of appeal rights, we use the term transfer of appeal rights on the related form and for communication to beneficiaries.  For the remainder of these instructions, we will also use t he term transfer instead of assignment of appeal rights, whenever appropriate.  The transfer of appeal rights is valid for the duration of the appeal, unless revoked by the beneficiary.   270.2.2 - Who May Be an Assignee  (Rev. 1274, Issued: 06- 29-07, Effective: 07 -01-07, Implementation: 10- 01-07)  Only a provider or supplier that is not a party to the initial determination and furnished an item or service to the beneficiary may accept the transfer of a beneficiarys appeal rights for that item or service.   An individual or entity who is not a provider or supplier may not accept the transfer.  A provider or supplier that furnishes an item or service to a beneficiary may not accept the transfer for that item or service when considered a party to the initial de termination.   270.2.3 - How to Make and Revoke a Transfer of Appeal Rights  (Rev. 4278, Issued: 04- 12-19, Effective: 06 -13-19, Implementation: 06- 13-19)  The beneficiary making the transfer (assignor) and the provide r or suppli er accepting the transfer (assignee) must c ompl ete the CMS standardized Transfer of Appeal R ights form (F orm CMS-20031) .  This f orm is entitle d, Transfer of Appeal Rights.  No al ternative written instrument may be used.  Signatures may be handwritten, electronic, digital, and/or digitized.  B y signing the CMS-20031, the  provide r indi cates his/h er acceptance of being the assignee.  Page two o f the form provide s information to the  beneficiary about transferring appeal rights.  The form C MS-20031 is a vailable  on the C MS.gov website at:  http://www.cms.gov/Medicare/CMS -Forms/CMS -Forms/Downloads/CMS20031.pdf   A. Co mpleting a valid  Transfer of Appeal Rig hts Form CMS-20031  Form CMS-20031, T ransfer of Appeal R ights, is the  required form that beneficiaries must use  to assign the ir appeal  rights.  F ollowing ar e instructions for compl eting f orm CMS-20031.  1. Completing Section I - The name of the beneficiary transferring appeal r ights must be  clearly legible.  The be neficiarys Me dicare numbe r must be  provide d in this s ection.  This s ection in cludes name, Medicare number , address and ph one numb er, and the  item or service that is a t issu e.  The  beneficiary must provide a signature on the  transfer statement and inc lude the date.  Only the beneficiary may sign this s ection.   2.   C ompleting Section II - Acceptance of Appeal Rights - The provide r or suppli er acc epting the appeal  rights must c ompl ete this s ection.  This s ection in cludes name, address, and phone  num ber.  The provide r or suppli er must si gn this s ection to accept the t ransfer of appeal rights and agree not to collect payment (except f or any applicable d eductible or coinsur ance) from the  beneficiary for the item or service at issue, unless a v alid Adva nce Beneficiary Notice of N oncoverage (ABN) is in effect.  If an inc ompl ete form is submitte d, the  adjudi cator  should c ontact the  party and pr ovide  a description of  the missing  information.  Unl ess the  defect is c ured, the provider or suppli er lacks the  author ity to accept the  appeal r ights of  the beneficiary, and is not e ntitle d to t ake action r egarding the appeal or obtain or receive any information re lated to the  appeal, in cluding the appeal d ecision.  The  adjudicator  should not dismiss the  appeal reque st because  the transfer of appeal  rights is not  valid.  CMS permits the use of a rubber stamp in lieu of a handwritten signature in accordance with the Rehabilitation Act of 1973 in the case of an author with a physical disability that can provide proof to a CMS MAC of his or her inability to sign their signature due to their disability.  By affixing the rubber stamp, the person is cer tifying that they have reviewed the document.  B. Waive r of Right to Payment for the Items or Services a t Issu e  The provide r or suppli er who acc epts the  appeal rights must w aive the right to collect p ayment from the  beneficiary for the item or service that is the  subj ect of the appeal.  The provider or suppli er may collect any applicable  deductible or coinsura nce.  The  provider or suppli er agrees to this w aiver by compl eting and signing Section  II of the Transfer of App eal Rights form.  The w aiver to collect payment remains in effect regardless of the outcome of the appeal decision.   This w aiver remains va lid unl ess the  transfer is revoke d by the beneficiary as described in subs ection D, below.  C. Du ration of a Valid  Transfer of Appeal Rig hts  Unless revoke d, the transfer of appeal  rights is v alid for all levels of the appeal p rocess including judi cial review, even in the  event of the death of  the beneficiary.  D. Re voking a T ransfer of Appeal Rig hts  The party assigning the ir app eal rights m ay revoke the transfer of appeal  rights b y providi ng a written statement of revocation to the  adjudi cator  at any time.  If revoke d, the rights to a ppeal re vert to the  beneficiary.  The transfer may be revoked in the  following  ways: