Appeals Council Review is which level?

• A. The first level of Medicare appeal
• B. The second level of Medicare appeal
• C. The third level of Medicare appeal
• D. The fourth level of Medicare appeal

Answer: (D)

Appeals Council Review is the fourth level in the Medicare appeals process. After an initial determination by the Medicare Administrative Contractor, and then a reconsideration and a potential Administrative Law Judge hearing, the next step is the Council’s review of the ALJ decision. The Appeals Council checks for legal errors on the record and can overturn, modify, or uphold the ALJ’s decision. If still unresolved, the case can proceed to federal district court after this level.