The Centers for Medicare & Medicaid Services (CMS) announced the annual adjustment in the amount in controversy (AIC) thresholds for Administrative Law Judge (ALJ) hearings and judicial reviews under the Medicare appeals process. For requests for ALJ hearings filed on or after January 1, 2017, the AIC threshold will be $160. For requests for judicial reviews filed on or after January 1, 2017, the AIC threshold will be $1,560.
This is an increase from the 2016 AIC thresholds, which were $150 for ALJ hearings and $1,500 for judicial reviews. The AIC sets the threshold for the minimum claim amount that can be brought before an ALJ or judicial review, the third and fourth levels of the audit claims appeal process.
