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September 2003
 Medicare Appeals:
Disparity between Requirements and Responsible Agencies'
Capabilities
Applicants and others have been
concerned about the length of time it takes for a decision on the
appeal of a denied Medicare claim. In December 2000, the Medicare,
Medicaid, and SCHIP Benefits Improvement and Protection Act of
2000 (BIPA), required, among other things, shorter decision time
frames. BIPA's provisions related to Medicare appeals were to be
applied to claims denied after October 1, 2002, but many of the
changes have not yet been implemented. GAO was asked to evaluate
whether the current Medicare appeals process is operating
consistent with BIPA's requirements and to identify any barriers
to meeting the law's requirements.
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