Medicare Appeals Case Processing Manual Revised

Medicare
 
Published:December 15, 2021
Dan Ciolek

Last week, the U.S. Department of Health and Human Services (HHS) Office of Medicare Hearings and Appeals (OMHA) published eight revised chapters of the OMHA Case Processing Manual (OCPM). The OCPM standardizes the day-to-day procedures for carrying out adjudicative functions, in accordance with applicable statutes, regulations, and OMHA directives, and gives OMHA staff direction for processing appeals at the OMHA level of adjudication. As part of an ongoing effort to make the manual more user friendly and reflect recent regulatory changes, OMHA is in the process of drafting new OCPM chapters and revising existing chapters under a new format. 

The following revised chapters required technical updates due to an update to eCFR.gov, which resulted in several hyperlinks becoming non-functioning. In addition, Chapter 11 required an update to the annual Amount in Controversy threshold chart, and several other chapters required minor technical updates.  

  • Chapter 4; Parties [Revisions to section 4.4.1.3] 
  • Chapter 5; Representatives [Revisions to section 5.2.1.2, 5.4.1, 5.4.3] 
  • Chapter 7; Adjudication Time Frames, Case Prioritization, and Escalations [Revisions to section 7.1.1.1, 7.1.1.2, 7.1.4.1, 7.2.1, 7.2.2, 7.3.1, 7.3.2, 7.3.4, 7.4.3, 7.5.2, 7.5.4, 7.5.5, 7.5.6, 7.5.8, 7.5.9] 
  • Chapter 10; Party and Non-Party Participant Requests and Submissions [Revisions to sections 10.5.2, 10.5.3, 10.7.10.1, 10.7.11, 10.7.11.1, 10.7.11.2] 
  • Chapter 11; Procedural Review and Determinations [Revisions to sections 11.3.2, 11.4.5] 
  • Chapter 16; Decisions [Revisions to section 16.4.3] 
  • Chapter 17; Dismissals [Revisions to sections 17.1.4, 17.1.5.2, 17.1.5.4, 17.1.11.1, 17.2.1] 
  • Chapter 20; Post-Adjudication Actions [Revisions to sections 20.1.4, 20.2.2, 20.4.3, 20.5.3, 20.6.2, 20.6.3.1, 20.6.3.2, 20.6.6.1, 20.6.8, 20.7.1.2, 20.7.1.3, 20.7.1.5, 20.7.2, 20.7.3.1, 20.7.8, 20.8.1.2, 20.8.1.4, 20.8.1.5, 20.8.1.6, 20.8.2, 20.8.3.1, 20.8.3.2, 20.8.3.3, 20.10.4; 20.5.3, 20.6.4, 20.7.4, 20.8.4, 20.9.2, 20.11.2] 

See the OCPM website links below for a full list of updates. 


 

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