{"abstract":"Medicare beneficiaries and, under certain circumstances, providers and suppliers of health care services, can appeal adverse determinations regarding claims for benefits under Medicare Part A and Part B under sections 1869 and 1879 of the Social Security Act (the Act). Section 521 of the Medicare, Medicaid, and SCHIP Benefits Act of 2000 (BIPA) amended section 1869 of the Act to provide for significant changes to the Medicare claims appeal procedures. This interim final rule responds to comments on the November 15, 2002 proposed rule regarding changes to these appeal procedures, establishes the implementing regulations, and explains how the new procedures will be implemented. It also sets forth provisions that are needed to implement the new statutory requirements enacted in Title IX of the Medicare Prescription Drug, Improvement, and Modernization Act of 2003 (MMA).","action":"Interim final rule with comment period.","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/2005/03/08/05-4062.html","cfr_references":[{"chapter":null,"citation_url":null,"part":401,"title":42},{"chapter":null,"citation_url":null,"part":405,"title":42}],"citation":"70 FR 11420","comment_url":null,"comments_close_on":null,"correction_of":null,"corrections":[],"dates":"Effective date: These regulations are effective on May 1, 2005. However, in view of the wide span of applicability of these rules and the complex, intertwined nature of the affected appeal procedures, not all of these provisions can be implemented simultaneously. Please see section I.E. of the preamble for a full description of the implementation approach.","disposition_notes":null,"docket_ids":["CMS-4064-IFC"],"dockets":[],"document_number":"05-4062","effective_on":"2005-05-01","end_page":11499,"executive_order_notes":null,"executive_order_number":null,"full_text_xml_url":"https://www.federalregister.gov/documents/full_text/xml/2005/03/08/05-4062.xml","html_url":"https://www.federalregister.gov/documents/2005/03/08/05-4062/medicare-program-changes-to-the-medicare-claims-appeal-procedures","images":{"ER08MR05.000":{"large":"https://img.federalregister.gov/ER08MR05.000/ER08MR05.000_large.png","medium":"https://img.federalregister.gov/ER08MR05.000/ER08MR05.000_medium.png","original_size":"https://img.federalregister.gov/ER08MR05.000/ER08MR05.000_original_size.png"}},"images_metadata":{"ER08MR05.000":{"large":{"identifier":"ER08MR05.000","content_type":"image/png","size":45397,"width":823,"sha":"fb1ab954025d838e76078c568c6ca176","url":"https://img.federalregister.gov/ER08MR05.000/ER08MR05.000_large.png","height":630},"medium":{"identifier":"ER08MR05.000","content_type":"image/png","size":21966,"width":538,"sha":"343a87de10331c4be18191ea11a013d7","url":"https://img.federalregister.gov/ER08MR05.000/ER08MR05.000_medium.png","height":412},"original_size":{"identifier":"ER08MR05.000","content_type":"image/png","size":167858,"width":4059,"sha":"907ac1e395b52ed27d5cc5a82e80dbe6","url":"https://img.federalregister.gov/ER08MR05.000/ER08MR05.000_original_size.png","height":3105}}},"json_url":"https://www.federalregister.gov/api/v1/documents/05-4062?publication_date=2005-03-08","mods_url":"https://www.govinfo.gov/metadata/granule/FR-2005-03-08/05-4062/mods.xml","not_received_for_publication":null,"page_length":80,"page_views":{"count":2447,"last_updated":"2026-09-21 06:15:03 -0400"},"pdf_url":"https://www.govinfo.gov/content/pkg/FR-2005-03-08/pdf/05-4062.pdf","presidential_document_number":null,"proclamation_number":null,"public_inspection_pdf_url":null,"publication_date":"2005-03-08","raw_text_url":"https://www.federalregister.gov/documents/full_text/text/2005/03/08/05-4062.txt","regulation_id_number_info":{"0938-AM73":{"issue":"201004","html_url":"https://www.federalregister.gov/regulations/0938-AM73/revisions-to-the-appeals-process-for-initial-claim-determinations-cms-4064-f-","title":"Revisions to the Appeals Process for Initial Claim Determinations (CMS-4064-F)\n","xml_url":"http://www.reginfo.gov/public/do/eAgendaViewRule?pubId=201004&RIN=0938-AM73&operation=OPERATION_EXPORT_XML","priority_category":"Other Significant"}},"regulation_id_numbers":["0938-AM73"],"regulations_dot_gov_info":{"checked_regulationsdotgov_at":"2011-11-12T15:40:08Z"},"regulations_dot_gov_url":null,"significant":true,"signing_date":null,"start_page":11420,"subtype":null,"title":"Medicare Program: Changes to the Medicare Claims Appeal Procedures","toc_doc":"Claims appeal procedures; changes","toc_subject":"Medicare:","topics":["Administrative practice and procedure","Claims","Freedom of information","Health facilities","Health professions","Kidney diseases","Medical devices","Medicare","Privacy","Reporting and recordkeeping requirements","Rural areas","X-rays"],"type":"Rule","volume":70}