CMS Pub. 100-04, ch. 29, § 270.1.4

In representing an appellant before a MAC, the representative has certain rights and responsibilities.

A. Authority of an Appointed Representative

A representative may represent a party in an appeal of a claim. An appointed representative may, on behalf

of the party; obtain appeal information about the claim to the same extent as the party, submit evidence,

make statements about facts and law, and make any request, or give or receive, any notice about the appeal

proceedings.

When a MAC takes action or issues a redetermination, it shall send notice to only the appointed

representative. Notice shall not be sent to the party if there is an appointed representative.

The MAC shall send any requests for information or evidence regarding an appeal only to the appointed

representative.

See also, §270.3 for MSP specific requirements.

B. Responsibilities of an Appointed Representative

An appointed representative must-

• Inform the party of the scope and responsibilities of the representation;

• Inform the party of the status of the appeal and the results of actions taken on behalf of the party such

as notification of appeal determinations, decisions, and further appeal rights;

• Disclose to a beneficiary any financial risk and liability of a non-assigned claim that the beneficiary

may have;

• Not act contrary to the interest of the party; and

• Comply with all laws and CMS regulations, CMS Rulings, and instructions.

The appointment of a representative by a party must be made freely and without coercion. The MAC should

assume that a representative is not making false or misleading statements, representations, or claims about

any material fact affecting any person’s rights. However, if the MAC has reason to believe that the

representative is making false or misleading statements, representations or claims about any material fact

affecting any person’s rights, it should refer the matter to the Unified Program Integrity Contractor (UPIC),

which were formerly known as Zone Program Integrity Contractors. A representative will have access to

personal and confidential medical and other information about a beneficiary. The MAC may assume that the

representative will not disclose personal or confidential information about a beneficiary except as necessary

to pursue an appeal on behalf of the party represented. Further, it may assume that a representative is not

disclosing any personal or confidential medical or other information about a beneficiary(ies) outside of the

appeals process.

Unless otherwise directed by the party making the appointment, the MAC need not keep the represented

party informed of the purpose of the appointment, the scope of the appointment, and exactly when/under

what circumstances the appointment will be exercised, since it may assume the representative has taken on

this responsibility. It is the responsibility of the representative to keep the party informed on the progress of

an appeal.

C. Delegation of Appointment by Appointed Representative

An appointed representative may delegate the appointment if the following conditions are met;

• The appointed representative provides written notice to the party of the appointed representative’s

intent to delegate to another individual. The notice must include the name of the designee and the

designee’s acceptance to be obligated and comply with the requirements or representation under this

subpart.

• The party accepts the designation by signing a written statement to that effect. This signed statement

is not required when the appointed representative and designee are attorneys in the same law firm or

organization.