Curing a Defective Transfer of Appeal Rights

270.2.8 - Curing a Defective Transfer of Appeal Rights (Rev. 4278, Issued: 04-12-19, Effective: 06-13-19, Implementation: 06-13-19) If any one of the elements is missing from the CMS-20031, the MAC shall contact the party and provide a description of the missing documentation or information. If the defect is not cured, the prospective assignee of appeal rights lacks the authority to act on behalf of the party, and is not entitled to obtain or receive any information related to the appeal, including the appeal decision. The MAC shall provide help and assistance to the beneficiary and provider or supplier in securing the transfer of appeal rights, based on the time frames set forth below. A. Timely Filed Appeal Request with a Defective Transfer of Appeal Rights When an incomplete or defective transfer of appeal rights form is received, the MAC shall notify both the provider/supplier submitting the CMS-20031 and the beneficiary. The MAC shall advise them why the transfer is defective, and describe the missing information that is required to complete the transfer. This may be done by telephone or written notification. The method, time and date of any notification shall be documented in the case file. A corrected/completed transfer may be submitted to the MAC by mail, or at the MAC’s discretion, by facsimile or a secure Internet portal/application, within 14 days. Should the CMS- 20031 not be corrected within this time limit, the MAC proceeds with processing and rendering a decision on the appeal. It sends the appeal decision to the beneficiary and any other party to the appeal, but not to the unauthorized assignee. This will ensure that the beneficiary receives an appeal, as the presumption here is that the appeal originated with the beneficiary and was submitted with the beneficiary’s knowledge and consent. However, if the MAC has information or evidence that the transfer was not submitted at the request of the beneficiary, it shall not conduct the appeal unless and/or until it receives confirmation from the beneficiary that the request was submitted with the beneficiary’s approval. B. Untimely Appeal Request Submitted With an Incomplete or Defective Transfer Because an untimely-filed appeal request is not always dismissed (e.g., there could be the finding of good cause for late filing, see §240.1), an incomplete or defective CMS-20031 may, in some cases, need to be corrected. If an incomplete or defective CMS-20031 needs to be corrected, the MAC shall follow the instructions contained in Section A above, prior to proceeding with the appeal request. C. Untimely Appeal Request Submitted With a Valid Transfer These cases should be resolved solely on the basis of whether there is good cause. (See §240.1.)