What You Need to Know


Medicaid Appeals Process Facts

There are as many Medicaid Appeals systems as there are States, and each one is different. Depending on the State you are in, there are unique arguments and defenses that can help you avoid overpayment assessments.



Medicare Appeals Process Facts

  • They will take your money if you do not appeal immediately after assessment.
  • They must stop once you appeal to the MAC/Carrier for re-determination.
  • They will begin to take your money again if you do not appeal immediately after the re-determination decision is received.
  • If you appeal to the QIC, they must stop off-set again, but you must include all of your arguments and documents at this level of appeal, so make sure you are ready before the re-determination decision is even received.
  • After you receive the QIC’s decision, you can no longer keep Medicare from off-setting your payments (keeping the money they owe you and crediting the balance you owe them) during the remainder of the appeals process, but they must accept a payment plan. The application can take a while. Start gathering the documents early on so that you will be ready when you need to submit it.