Appealing a Medicare PSOD decision

 

Standard pre-service reconsiderations or appeals

Under Part C rules, the member, their representative or their physician have the right to appeal a Medicare PSOD decision. Upon providing notice to the member, the member's physician can request a standard reconsideration or appeal without submitting proof that the physician is the member's personal representative.

• See the provider process for filing a Medicare appeal
• See the member process for filing a Medicare appeal

Expedited reconsiderations

Expedited appeal requests are for situations where applying the standard procedure could seriously jeopardize the member's life, health or ability to regain maximum function. The member, their representative or any physician or staff of physician's office acting on said physician's behalf may submit an expedited appeal request on behalf of the member.

 

Looking for information on post-service appeals? See instruction for contracted providers and non-contracted providers.