Medicare Appeals, Accountability and Errors
Part 3, Chapter 9: Medicare and Medicare Related Programs: Medicare Page 13
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The Medicare Beneficiary Incentive Program is also intended to encourage Medicare beneficiaries to recommend changes in program rules that may save money. The Portability and Accountability Act provided that Medicare may also share a portion of those savings with the beneficiary who originally suggested the idea.
While the government has been willing to begin dealing with the issue of Medicare finances, it seems reluctant to deal with the administrative difficulties that have resulted from the existing system of rules, regulations, and exceptions. In the mean time, the complex structure of the Medicare program continues to create confusion and makes the system far more difficult for consumers than it needs to be.
Fortunately, there is help available for Medicare beneficiaries who are experiencing difficulties. The Medicare appeals system is designed to help consumers deal with situations in which an error has occurred, or in which a claim has not been processed properly. The first step in that system is to file a claim appeal with the local carrier that processed the claim. If that's unsuccessful, a Medicare decision can be appealed further by requesting a Fair Hearing or by filing an appeal with an Administrative Law Judge or with the Appeals Council. However, in many cases, that appeals system can be complicated and time-consuming.
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