Medicare Financial Management Manual (Pub. 100-06), Ch. 6 § 110.2
Exhibit 2
110.2 – Exhibit 2
(Rev. 45, 05-28-04)
Medicare Program - Intermediary Part A and Part B Appeals Report - Form CMS-2591, Screen 2.
INTERMEDIARY APPEALS REPORT
INTERMEDIARY ID
REPORTING PERIOD
A. INTERMEDIARY APPEAL
REQUESTS
PART A RECONSIDERATIONS
TOTAL
SNF
HHA/HOSPI
CE
OTHER
(1)
(2)
(3)
(4)
PROCESSING TIMES
13. AVERAGE
14. NO. COMPLETED 1-45 DAYS
15. NO. COMPLETED 46-60 DAYS
16. NO. COMPLETED 61-90 DAYS
17. NO. COMPLETED 91-120
DAYS
18. NO. COMPLETED OVER 120
DAYS
PENDING TIMES
19. CLOSING PENDING
20. NO. PENDING 1-45 DAYS
21. NO. PENDING 46-60 DAYS
22. NO. PENDING 61-90 DAYS
23. NO. PENDING 91-120 DAYS
24. NO. PENDING OVER 120
DAYS
Form CMS-2591 Screen 2