|1. First Steps|
|Review the Center for Medicare Advocacy’s Self-help Packets and coverage guidelines regarding the particular level of care involved in the appeal at: https://www.medicareadvocacy.org.|
|Watch for, receive and review the Medicare Reconsideration decision. If the decision denies Medicare coverage, you only have 60 days to appeal from the date of receipt of the decision (however, to be safe, we recommend appealing within 60 days of the actual letter date).
|2. Request a Hearing|
|Appeal the Reconsideration if it denies Medicare coverage and there is enough at issue. This is done by requesting an ALJ hearing.
|3. Hearing Preparation|
|Ask the doctor who ordered the care or service in question for a letter describing why the care or service was medically reasonable and necessary.
|Receive the supporting letter from your doctor.|
|4. Notice of Hearing|
|Watch for and receive the Notice of Hearing.
|Respond to the Notice of Hearing in Writing.
|5. Case File Review|
|Watch for the OMHA case file.
|If you have additional medical records to submit, including a supporting letter from your physician, paginate the records and submit a copy of them to the ALJ prior to the hearing. Do this by mail rather than by fax. Be sure and keep a copy of the records for yourself so that you can refer to them during the hearing.|
|6. ALJ Hearing|
|Attend the Hearing.
|7. ALJ Decision|
|Watch for and receive the ALJ Decision.