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Office of Hearings and Appeals

Volume I

Transmittal No. I-5-5-2-A

Division 5: Temporary Instructions

Subject: Provider Appeal Rights Under § 1879(e) of the Social Security Act


Section 1879(e) of the Social Security Act provides relief to a beneficiary when payment may not be made under Part A because of an unintentional, inadvertent, or erroneous action by a provider of services, which results in the transfer of a beneficiary to a noncertified portion or bed in the facility. In such cases, the provider of services is often held liable for the cost of the inpatient hospital or extended care services. The statute does not address the issue of provider appeal rights in such cases, leaving implementation of § 1879(e) to the Secretary's discretion.

Explanation of Content and Changes

This Temporary Instruction (TI) provides OHA policy with respect to the right of a provider of services to appeal a Medicare Part A case decided under § 1879(e) of the Social Security Act.




Insert TI 5-502, Supplement A.

Date: September 9, 1992