Fee-for-service physicians who disagree with a decision by Medicare with respect to billings or who have been assessed as owing money to Medicare through a formal audit or post-assessment exercise may appeal the Medicare decision according to appeal procedures set out in Regulation 84-20 of the Medical Services Payment Act.
Legislation requires physicians to first enter into discussions with the Department of Health to resolve the dispute. Most disputes are resolved at this stage, with NBMS Economics staff providing support to physicians during the discussions.
If the parties fail to resolve the dispute through discussion, the physician may request that the issue be referred to the Professional Review Committee or to an adjudicator.
To access the appeals process, physicians must:
- File a notice of appeal within 60 days of receipt of a final notice of assessment from Medicare;
- Pay in full all amounts assessed as owing before a hearing will be granted.
For more information, contact Renée Guignard McEvoy, Director, Fee-For-Service Physician Services, Claims Assessment and Medicare Systems, at (506) 453-6214 or renee.guignard@gnb.ca.