Health Care Business Appeals

Attorney Gus Suarez has extensive experience representing clients involved in Medicare appeals in Miami and throughout South Florida. The firm’s attorneys has have extensive experience in the handling of appeals involving provider suspensions and revocations.

Generally, (depending on the matter involved) health care providers, physicians and suppliers have 120 days from the date of the original Medicare Part A or Part B claim determination to file an appeal. The five levels of the Medicare Part A and Part B administrative appeals process are as follows:

Redetermination: After an appeal is filed, the initial decision is reviewed by a Medicare fiscal intermediary (FI), carrier or Medicare administrative contractor (MAC), and a redetermination can be made.

  • Reconsideration: If dissatisfied with the redetermination, a reconsideration by a qualified independent contractor (QIC) can be filed. The reconsideration may contain information on further appeal rights.
  • Administrative law judge (ALJ) hearing: A party to a reconsideration may request a hearing by an administrative law judge (ALJ) within 60 days of receipt of the reconsideration decision.
  • Review by the Medicare Appeals Council: Following an ALJ hearing, a request for a Medicare Appeals Council review can be filed if a party is unhappy with the results. The Appeals Council may issue a new decision.
  • U.S. District Court judicial review: If dissatisfied with the ALJ’s determination, a party may request judicial review before a U.S. District Court judge for a final decision.

In addition to Medicare and Medicaid appeals, the firm represents professionals and businesses in the health care industry and beyond in litigation, and regulatory and administrative appeals, including appeals of license suspensions and revocations.

Next Steps…

To learn more about the Medicare and Medicaid appeals process or to schedule a consultation email or call the firm at 305-443-8900. Se habla Español.

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