Medical Billing: How to File a Qualified Independent Contractor (QIC) Reconsideration - dummies

Medical Billing: How to File a Qualified Independent Contractor (QIC) Reconsideration

If your request for Medicare redetermination doesn’t resolve your billing dispute, as a medical billing professional, you may have to initiate a Qualified Independent Contractor (QIC) reconsideration. You must submit this request within 180 days of the receipt of your redetermination reply. The instructions for submitting this appeal are on the redetermination notice. You can also submit additional evidence.

The QIC is the last level of appeal that allows you to submit additional evidence, but the best approach is to submit all evidence with the initial request for redetermination. When you submit evidence later, you have to include with the evidence an explanation as to why you didn’t submit it with the original request and why it’s now relevant.

To file a QIC, you must use the reconsideration request form (CMS-20033) which you can find on the CMS website. If you choose not to use this form, be sure to include the following information on your request:

  • Beneficiary (patient) name and Medicare number.

  • The specific service(s) or item(s) for which the reconsideration is being requested, along with the date of service.

  • The name and signature of the provider. As the representative of the provider, you use your name and sign the form.

  • The name of the Medicare contractor who made the redetermination. To save time, you also want to include a copy of the redetermination.

  • An explanation why you still disagree with the processing.

  • Any additional evidence, along with explanations for why you didn’t submit this information earlier and why it’s relevant now. (Medicare may exclude evidence that has been submitted late unless you can show good cause for submitting it late.)

The QIC written decision is normally received within 60 days and contains an explanation of the ruling and information regarding whether an additional level of appeal is available. The next level is to take your appeal to an Administrative Law Judge. Additional evidence is not allowed at the upper level of appeal unless you have a documented reason why the evidence was not previously submitted.