Medicare Appeals Council

E500284

Medicare appeals body appellate review entity federal administrative body

The Medicare Appeals Council is a federal body that reviews and issues final administrative decisions on Medicare coverage and payment appeals.

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Statements (47)

Predicate	Object
instanceOf	Medicare appeals body ⓘ appellate review entity ⓘ federal administrative body ⓘ
applies	Medicare regulations ⓘ Medicare statutes ⓘ binding federal court precedent within applicable jurisdiction ⓘ sub-regulatory Medicare guidance ⓘ
canReview	certain decisions of Qualified Independent Contractors when ALJ review is unavailable ⓘ decisions of Medicare Administrative Law Judges ⓘ dismissals issued by Medicare Administrative Law Judges ⓘ
country	United States of America ⓘ surface form: United States
decisionType	dismissal of request for review ⓘ final administrative decision ⓘ
goal	ensure consistent application of Medicare law and policy in appealed cases ⓘ
issues	orders ⓘ remand orders ⓘ written decisions ⓘ
jurisdiction	Medicare program NERFINISHED ⓘ
legalAuthority	42 C.F.R. Part 405, Subpart I ⓘ Medicare regulations in Title 42 of the Code of Federal Regulations ⓘ Social Security Act NERFINISHED ⓘ
mayAffirm	Administrative Law Judge decision ⓘ
mayAllow	oral argument in its discretion ⓘ
mayModify	Administrative Law Judge decision ⓘ
mayRemand	case to an Administrative Law Judge ⓘ
mayReverse	Administrative Law Judge decision ⓘ
partOf	Office of Medicare Hearings and Appeals NERFINISHED ⓘ U.S. Department of Health and Human Services NERFINISHED ⓘ
partyTypes	Medicare beneficiaries ⓘ Medicare contractors in certain cases ⓘ Medicare providers ⓘ Medicare suppliers ⓘ
positionInProcess	final level of administrative review before federal court in Medicare appeals ⓘ fourth level of the Medicare administrative appeals process ⓘ
procedure	paper review based on the administrative record ⓘ
publishes	selected decisions as precedential or of general interest ⓘ
requires	timely request for review by a party ⓘ
reviews	Medicare coverage appeals ⓘ Medicare payment appeals ⓘ
role	conducts de novo review of appealed Medicare decisions ⓘ issues final administrative decisions in Medicare appeals ⓘ reviews decisions of Administrative Law Judges in Medicare appeals ⓘ
scopeOfReview	limited to issues raised in the request for review unless expanding is necessary to correct an error ⓘ
subjectMatter	coverage of Medicare items and services ⓘ entitlement to Medicare benefits in certain contexts ⓘ payment amounts under Medicare ⓘ
subjectToReviewBy	federal district court ⓘ

Referenced by (1)

Full triples — surface form annotated when it differs from this entity's canonical label.

National Coverage Determinations → bindingOn → Medicare Appeals Council ⓘ