Reconsideration is which level of appeal in the Medicare claims process?

• A. The first level of appeal
• B. The second level of appeal
• C. The final level of appeal
• D. An informal review

Answer: (B)

Reconsideration is the second level of appeal in the Medicare claims process. After a claim denial, the first step is a redetermination by the Medicare Administrative Contractor. If you still disagree, you move to reconsideration, which is handled by a Qualified Independent Contractor. This is the formal next step before any in-depth hearing or higher reviews. If the reconsideration is not favorable, the process continues to an Administrative Law Judge hearing, then a review by the Medicare Appeals Council, and finally potential federal court review. The option of an informal review isn’t part of the formal ladder, and the first step is redetermination, not reconsideration, making reconsideration the second level.