A beneficiary who disagrees with a claim decision under Original Medicare begins the appeal process with:
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Answer & full 3-part explanation (select an option above, or peek)
Why A is correct
Medicare's appeal process is laddered. The first level is a redetermination by the claims contractor, the Medicare Administrative Contractor or other entity, that made the original payment decision. If the beneficiary is unsatisfied with the redetermination, the appeal proceeds to reconsideration by an independent review entity, then to an Administrative Law Judge, then the Medicare Appeals Council, and finally judicial review in federal court. Starting at the bottom of the ladder with a redetermination request is required before any higher level can be reached, and each step has its own deadlines and filing rules.
Why the other options are wrong
- B) Federal court is the last rung of the appeal ladder and is unreachable until all lower administrative levels have been exhausted through the required sequence.
- C) Medicare claim appeals are handled through the federal appeal process, not through state insurance departments, which regulate insurers rather than Medicare claims contractors.
- D) HICAP provides free counseling and education to help beneficiaries understand their Medicare rights and options, but it does not pay or decide disputed claims.
Memory hook
Medicare appeals climb a ladder: redetermination first, court last. No skipping rungs.