Level Five Appeal
Judicial Review in U.S. District Court
If $1,130 (2007 threshold) or more is still in controversy following the Appeals Council’s decision, a party to the decision may request judicial review before a U.S. District Court Judge.
Note: The amount in controversy (AIC) required to request judicial review is increased annually by the percentage increase in the medical care component of the consumer price index for all urban consumers.
Requesting Judicial Review in District Court
The appellant must file the request for review within 60 days of receipt of the Appeals Council’s decision.
The Appeals Council’s decision will contain information about the procedures for requesting judicial review.
None unless required by the District Court Judge.
Varies by case.
Section 911 of the Medicare Prescription Drug, Improvement, and Modernization Act of 2003 (MMA) enacted numerous contracting reforms that can impact the claims audit and appeals processes. Check often for new developments: Medicare Contracting Reform Updates