Appeals for Beneficiary Protection Any hospital, provider, plan or facility that accepts Medicare payment for services is required to provide only the services that are medically necessary.
To meet this requirement, health care providers establish review committees to decide whether a Medicare beneficiary’s care is medically necessary. If not, they must give the beneficiary a notice explaining the decision. However, the internal committee does not have the final say regarding Medicare payment.
WVMI has the authority to make Medicare payment decisions when a beneficiary disagrees with a notice. The following links provide more information about appeals.