42 C.F.R. § 478.44 Determining the amount in controversy for a hearing.
Title 42 - Public Health
(a) After an individual appellant has submitted a request for a hearing, the ALJ determines the amount in controversy in accordance with §405.740(a) of this chapter for Part A services or §405.817(a) of this chapter for Part B services. When two or more appellants submit a request for hearing, the ALJ determines the amount in controversy in accordance with §405.740(b) of this chapter for Part A services and §405.817(b) of this chapter for Part B services. (b) If the ALJ determines that the amount in controversy is less than $200, the ALJ, without holding a hearing, notifies the parties to the hearing that the parties have 15 calendar days to submit additional evidence to prove that the amount in controversy is at least $200. (c) At the end of the 15-day period, if the ALJ determines that the amount in controversy is less than $200, the ALJ, without holding a hearing, dismisses the request for a hearing without ruling on the substantive issues involved in the appeal and notifies the parties to the hearing and the QIO that the QIO reconsidered determination is conclusive for Medicare payment purposes. [50 FR 15372, Apr. 17, 1985, as amended at 59 FR 12184, Mar. 16, 1994. Redesignated at 64 FR 66279, Nov. 24, 1999]
Title 42: Public Health
PART 478—RECONSIDERATIONS AND APPEALS
Subpart B—Utilization and Quality Control Quality Improvement Organization (QIO) Reconsiderations and Appeals
§ 478.44 Determining the amount in controversy for a hearing.
