General Guidelines

290.1 - General Guidelines (Rev. 2729, Issued: 06-21-13, Effective: 07-23-13, Implementation: 07-23-13) MACs shall prepare appeals correspondence so the appellant can easily understand both the reason why any of the services were not covered or could not be fully reimbursed, and what action the appellant can take if the appellant disagrees with that decision. In addition, the guidelines listed here should be followed to the extent possible: • Keep the language as simple as possible; • Do not use abbreviations or jargon; • Choose a positive rather than a negative tone, whenever possible. Avoid words or phrases that emphasize what cannot be done by the MAC or the appellant; • If possible, avoid one sentence paragraphs, uneven spacing between paragraphs, etc.; • Apologize when appropriate, e.g., if the response is late. However, do not apologize for enforcing Medicare guidelines that may be adverse to the appellant’s claim; • Summarize the question before providing a response; and, • Use correct spelling, grammar, and punctuation.