Medicare Financial Management Manual (Pub. 100-06), Ch. 6 § 110.6
Exhibit 6
110.6 - Exhibit 6
(Rev. 45, 05-28-04)
Medicare Program - Intermediary Part A and Part B Appeals Report - Form CMS-2591, Screen 6
INTERMEDIARY APPEALS REPORT
INTERMEDIARY ID
REPORT PERIOD
E. REOPENINGS (Claims Count)
PART A
TOTAL
(1)
PRE-
Recon
(2)
Post-
Recon
(3)
Post-ALJ
Hearing
(4)
84. TOTAL
85. UNFAVORABLE TO
CLAIMANT
86. NO CHANGE
87. FAVORABLE TO
CLAIMANT
88. AMOUNT AWARDED
PART B
TOTAL
Pre-
Review
Post-
Review
Post-
Hearing
89. TOTAL
90. UNFAVORABLE TO
CLAIMANT
91. NO CHANGE
92. FAVORABLE TO
CLAIMANT
93. AMOUNT AWARDED
Form CMS-2591 Screen 6