CMS Pub. 100-04, ch. 29, § 270.1.1

Any individual may be appointed to act as a representative unless he/she is disqualified, suspended, or

otherwise prohibited by law from acting as a representative in proceedings before HHS, or in entitlement

appeals, before SSA.

A MAC should not accept an appointment of representative if it has evidence that the appointment of

representative should not be honored. It should notify the party attempting to be represented and the

individual attempting to represent the party that the appointment will not be honored. A specific individual

must be named as the representative. An organization or entity may not be named as a representative, but

rather a specific member of that organization or entity must be named. This ensures that confidential

beneficiary information is released only to the individual so named.

A provider or supplier who files an appeal request on behalf of a beneficiary is not, by virtue of filing the

appeal, a representative of the beneficiary. To act as the beneficiary’s representative, the provider or

supplier must execute a valid appointment as described in this section.

If the requestor is the beneficiary’s legal guardian, surrogate decision-maker for an incapacitated beneficiary,

an SSA-appointed representative payee (See IOM Pub. 100-01, Chapter 6, §10.K. for information regarding

SSA rep payees), or is otherwise authorized under State law, no appointment is necessary, and the requestor

is considered an authorized representative. All MACs shall document the representative’s authority to act

on behalf of the beneficiary in the case file. (See §270.1.7 for information on power of attorney.)

NOTE: Billing clerks or billing services employed by the provider or supplier to prepare and/or bill the

initial claim, process the payments, and/or pursue appeals act as the agent of the provider or supplier and do

not need to be appointed as representative of the provider/supplier. Include evidence in the case file if the

physician or other supplier employs a billing clerk or billing service (a screen print showing that payment is

made to the billing clerk or billing service is sufficient.) If the billing clerk/billing service is not authorized

to receive payment, but is authorized to process payments and/or pursue appeals, include evidence in the

case file. If the agreement is on file, make a notation in the case file where the agreement can be located.

(See the Medicare General Information, Eligibility, and Entitlement Manual, which allows payment to be

made to an agent who furnishes billing or collection services.)

The following is a list of the types of individuals who could be appointed to act as representative for a party

to an appeal. This list is not exhaustive, and is meant for illustrative purposes only:

• Congressional staff members;

• Family members of a beneficiary;

• Friends or neighbors of a beneficiary;

• Member of a beneficiary advocacy group;

• Member of a provider or supplier advocacy group;

• Attorneys; and

• Physicians or suppliers.