Reimbursement: CMS Increases 2020 AIC Medicare Appeal Thresholds

Appealing Medicare denials and other unfavorable decisions will be just a tad more difficult in 2020. Here’s why: Medicare AIC Thresholds Medicare rules (specifically, Section 1869(b)(1)(E) of the Social Security Act), establish amount in controversy (AIC) thresholds for Medicare Part A, Part B or Part D appeals. There are two AIC thresholds: One for appeals to an Administrative Law Judge (ALJ); and One for court appeals. 2020 AIC Thresholds CMS is required to adjust both AIC thresholds each year according to the consumer price index. On Oct. 7, the agency published new increases to the AIC thresholds for 2020, (i.e., effective for appeals filed on or after Jan. 1, 2020): ALJ appeals: $170, as opposed to $160 in 2019; and Court appeals: $1,670, as opposed to $1,630 in 2019.