CMS Pub. 100-04, ch. 29, § 240

for Filing Appeals

(Rev. 4278, Issued: 04-12-19, Effective: 06-13-19, Implementation: 06-13-19)

A. Time Limits for Each Level of Appeal

The time limits for filing appeals vary according to the type of appeal:

• Redetermination - The time limit for filing a request for redetermination is 120 days from the

date of receipt of the Medicare Summary Notice (MSN) or Remittance Advice (RA). See §240.1-

240.5 for clarifications and exceptions to this rule.)

• QIC Reconsideration - The time limit for filing a request for reconsideration is 180 days from the

date of receipt of the notice of the redetermination. If a party requests QIC review of a MAC’s

dismissal of a request for redetermination, the time limit for filing is 60 days from the date of receipt

of the MAC’s dismissal notice.

• ALJ Hearing - The time limit for filing a request for an ALJ hearing is 60 days from the date of

receipt of the reconsideration notice.

• Appeals Council Review - The time limit for filing a request for review by the Appeals Council is

60 days from the date of receipt of the ALJ’s or attorney adjudicator’s decision.

• Judicial Review - The time limit for filing for judicial review is 60 days from the date of the

Appeals Council's decision.

A request filed with the A/B MAC (A), (B), (HHH), or DME MAC is considered to have been filed as of the

date the MAC received it. The MAC computes the time limit for requesting a redetermination by allowing 5

additional days beyond the time limit (120 days for a redetermination) from the date of the previous notice.

This allows a 5-day period for mail delivery. The MAC allows for additional time if there is evidence that

the mail delivery was longer than 5 days.

NOTE: When the beneficiary preference is to have all documents converted into an accessible format,

MACs shall make allowances for additional delivery time of the accessible format. The MAC shall also

provide allowance for a delayed response as a result of a beneficiary having sought and received help from

an auxiliary resource (such as a SHIP or senior center), on account of his or her disability, in order to be able

to file an appeal (also see §240.2).

When the filing deadline for a redetermination ends on a Saturday, Sunday, legal holiday, or any other

nonwork day, the MAC shall apply a rollover period that extends the filing deadline to the first working day

after the Saturday, Sunday, legal holiday, or other nonwork day. For example, if the filing deadline for a

redetermination falls on the Saturday before Columbus Day, the filing deadline is extended to the first

working day after the Columbus Day holiday.

These time limits may be extended if good cause for late filing is shown. (See §240.1-240.5.) When a

redetermination request appears to be filed late, the MAC makes a finding of good cause using the

guidelines in §240.2 through §240.4 before taking any other action on the appeal.

B. Extension of Time Limit for Filing a Request for Redetermination

The time limit for filing a request for redetermination may be extended in certain situations. Generally,

providers, physicians or other suppliers are expected to file appeal requests on a timely basis. A re quest

from a provider, physician, or other supplier to extend the period for filing the request for redetermination

should not be routinely granted and such requests warrant careful examination. For a beneficiary request,

more lenience should be given.

Upon request by the party that has missed the filing deadline, the A/B MAC (A), (B), (HHH), or DME MAC

may extend the period for filing the request for redetermination. The procedures for finding good cause to

excuse late filing are discussed below.