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How to appeal a Medicare contract revocation

On Behalf of | Aug 2, 2021 | Health Care, Medicare & Medicaid |

Revocation of Medicare and Medicaid contracts can significantly damage your practice and affect your ability to operate in your field.

It is crucial to understand your appeal rights to avoid the potential issues that can result from revocation.

The initial steps of a Medicare revocation appeals process

If your denial is due to deficiencies you can correct, you may submit a corrective action plan. There are strict deadlines and requirements, and your strategy must contain sufficient proof of compliance.

If your revocation is the result of wrongdoing by an employee or other personnel, you may be able to reverse it by terminating your relationship with the person. You must submit proof of your actions within 30 days to your contractor.

Presenting a reconsideration request within the specified deadline can help you keep your right to appeal. The evidence you offer needs to be comprehensive and accurate, as future appellate proceedings can reject any data that you did not initially include.

The following steps of your revocation appeal

If you are not successful at the reconsideration level, you can appeal the decision to an Administrative Law Judge hearing. A well-prepared case may settle before the hearing.

Within 60 days following an ALJ decision, you can appeal to the Departmental Appeals Board. The procedures and practices are unique in this final stage of administrative appeal, and the DAB can deny review if they do not feel the evidence is sufficient.

You may be able to seek federal judicial review following an unfavorable DAB result.

Medicare and Medicaid revocations can cause extensive loss of revenue and other potentially devastating consequences. It is vital to understand the rules, regulations and deadlines of each step of the appeals process to secure your ability to practice.