CMS limits of scope of MAC/QIO review for appeals

“Scope Creep” in Appeals is Dead

CMS has instructed MACs and QICs to limit their review to the reason(s) the claim or line item at issue was initially denied.

For redeterminations and reconsiderations of claims denied following a complex prepayment review, a complex post-payment review, or an automated post-payment review by a contractor,

Limiting the scope of review on redeterminations and reconsiderations of certain claims. MLN Matters Number SE1521. May 2016; Available at Accessed …

Via: CMS revises limitations of scope of review for redeterminations, reconsiderations


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