Latest News and Events

Please join us for WebEx Medicare's Expedited Appeals Process on April 3, 2008 .

New Rules for Medicare Expedited Determinations

On July 1, 2005, the Centers for Medicare and Medicaid Services (CMS) released a memorandum stating they have reevaluated their decision to allow Quality Improvement Organizations(QIOs) the authority to provide the physician certification statement that is required when beneficiaries in non-residential settings are requesting an appeal .

CMS has determined it is not appropriate for the QIOs to provide the physician certification statement and conduct the actual review of the case.

CMS has explained that the beneficiary must obtain the physician certification statement from a physician and supply it to the QIO.

Note to Providers:

QIOs, including MPRO, will accept beneficiary requests for expedited determinations even if the beneficiary does not submit the request within the required time frame. However, provisions related to beneficiary financial liability protection, and the 72-hour turn-around time frame for the QIO determination do not apply.