Part B claim challenges may be handled by phone

HCFA proposal would speed appeals

The Health Care Financing Administration (HCFA) has released a proposed rule change that would permit providers, patients, suppliers, and carriers to challenge Medicare Part B initial claim determinations by telephone.

Currently, claim appeals and responses must be submitted in writing and filed with HCFA and the carrier. After its initial decision, the carrier must give the provider (or another party) six months to request a review of the action. Upon the provider’s request, this initial review period can be extended an additional six months.

Under HCFA’s new rule, the current review time frames still stand. However, both providers and carriers would have the option of asking to have a decision reviewed by telephone.

Formalizing an informal process

HCFA notes that the current paper review process can be time-consuming. The agency also says both physicians and beneficiaries already frequently call the carrier to dispute a determination, to ask for clarification, or to protest a denial. HCFA wants to be able to turn these informal inquiries into a formal appeals pleading.

Besides saving time, HCFA hopes the process will provide more opportunity for an exchange of questions, answers, and explanations between the agency and providers, resulting in better give-and-take during the appeals process.

HCFA also considered the idea of letting providers file electronic or e-mail appeals, but decided to table that option for now.

The proposed rule is scheduled to go into effect Feb. 1, 2000. HCFA is accepting comments on the rule until Nov. 29. To submit comments, mail an original and three copies of written comments to:

Health Care Financing Administration

Department of Health and Human Services

Attention: HCFA-4121-FC

P.O. Box 9013

Baltimore, MD 21244-9013

To view the full text of the final rule on the Internet, go to: aces/aces140.html, and search under the date 09/30/99, with the search term "telephone."