{"abstract":"Under sections 1869 and 1879 of the Social Security Act (the Act), Medicare beneficiaries and, under certain circumstances, providers and suppliers of health care services, may appeal adverse determinations regarding claims for benefits under Medicare Part A and Part B. Section 521 of the Medicare, Medicaid and SCHIP Benefits Improvement and Protection Act of 2000 amends section 1869 of the Act to substantially revise the Medicare claim appeals process. The statute mandates a series of structural and procedural changes to the existing appeals process, including: The establishment of a uniform process for handling all Medicare Part A and Part B appeals; revised time limits for filing appeals; reduced decision-making time frames throughout all levels of the Medicare administrative appeals system; the introduction of new entities known as qualified independent contractors (QICs) to conduct reconsiderations of contractors' initial determinations or redeterminations; and the establishment of the right to an expedited determination when an individual disagrees with a provider's decision to discharge the individual or terminate services. This proposed rule sets forth the regulations that would be needed to implement the new statutory provisions.","action":"Proposed rule.","agencies":[{"raw_name":"DEPARTMENT OF HEALTH AND HUMAN SERVICES","name":"Health and Human Services Department","id":221,"url":"https://www.federalregister.gov/agencies/health-and-human-services-department","json_url":"https://www.federalregister.gov/api/v1/agencies/221","parent_id":null,"slug":"health-and-human-services-department"},{"raw_name":"Centers for Medicare & Medicaid Services","name":"Centers for Medicare & Medicaid Services","id":45,"url":"https://www.federalregister.gov/agencies/centers-for-medicare-medicaid-services","json_url":"https://www.federalregister.gov/api/v1/agencies/45","parent_id":221,"slug":"centers-for-medicare-medicaid-services"}],"body_html_url":"https://www.federalregister.gov/documents/full_text/html/2002/11/15/02-28296.html","cfr_references":[{"chapter":null,"citation_url":null,"part":405,"title":42}],"citation":"67 FR 69312","comment_url":null,"comments_close_on":"2003-01-14","correction_of":null,"corrections":[],"dates":"We will consider comments if we receive them at the appropriate address, as provided below, no later than 5 p.m. on January 14, 2003.","disposition_notes":null,"docket_ids":["CMS-4004-P"],"dockets":[],"document_number":"02-28296","effective_on":null,"end_page":69363,"executive_order_notes":null,"executive_order_number":null,"full_text_xml_url":"https://www.federalregister.gov/documents/full_text/xml/2002/11/15/02-28296.xml","html_url":"https://www.federalregister.gov/documents/2002/11/15/02-28296/medicare-program-changes-to-the-medicare-claims-appeal-procedures","images":{"EP15NO02.000":{"large":"https://img.federalregister.gov/EP15NO02.000/EP15NO02.000_large.png","medium":"https://img.federalregister.gov/EP15NO02.000/EP15NO02.000_medium.png","original_size":"https://img.federalregister.gov/EP15NO02.000/EP15NO02.000_original_size.png"}},"images_metadata":{"EP15NO02.000":{"large":{"identifier":"EP15NO02.000","content_type":"image/png","size":82335,"width":822,"sha":"647685a790390b3941cbf9ec489f17d5","url":"https://img.federalregister.gov/EP15NO02.000/EP15NO02.000_large.png","height":1275},"medium":{"identifier":"EP15NO02.000","content_type":"image/png","size":34548,"width":449,"sha":"4b9562a8550fcb4a33c28cba54884ed6","url":"https://img.federalregister.gov/EP15NO02.000/EP15NO02.000_medium.png","height":697},"original_size":{"identifier":"EP15NO02.000","content_type":"image/png","size":95780,"width":1698,"sha":"8b8c631a3ff8962f2902064fe88e0a70","url":"https://img.federalregister.gov/EP15NO02.000/EP15NO02.000_original_size.png","height":2635}}},"json_url":"https://www.federalregister.gov/api/v1/documents/02-28296?publication_date=2002-11-15","mods_url":"https://www.govinfo.gov/metadata/granule/FR-2002-11-15/02-28296/mods.xml","not_received_for_publication":null,"page_length":52,"page_views":{"count":726,"last_updated":"2026-08-25 14:15:04 -0400"},"pdf_url":"https://www.govinfo.gov/content/pkg/FR-2002-11-15/pdf/02-28296.pdf","presidential_document_number":null,"proclamation_number":null,"public_inspection_pdf_url":null,"publication_date":"2002-11-15","raw_text_url":"https://www.federalregister.gov/documents/full_text/text/2002/11/15/02-28296.txt","regulation_id_number_info":{"0938-AL67":{"issue":"200410","html_url":"https://www.federalregister.gov/regulations/0938-AL67/revisions-to-the-medicare-appeals-process-cms-4004-fc-","title":"Revisions to the Medicare Appeals Process (CMS-4004-FC)","xml_url":"http://www.reginfo.gov/public/do/eAgendaViewRule?pubId=200410&RIN=0938-AL67&operation=OPERATION_EXPORT_XML","priority_category":"Other Significant"}},"regulation_id_numbers":["0938-AL67"],"regulations_dot_gov_info":{},"regulations_dot_gov_url":null,"significant":true,"signing_date":null,"start_page":69312,"subtype":null,"title":"Medicare Program: Changes to the Medicare Claims Appeal Procedures","toc_doc":"Claims appeal procedures; changes","toc_subject":"Medicare:","topics":[],"type":"Proposed Rule","volume":67}