Certified Inpatient Coding (CIC) Practice Exam

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Prepare for the Certified Inpatient Coding Exam. Dive into comprehensive flashcards and multiple-choice questions, each with detailed explanations. Ensure success in your certification journey!

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What is the timeframe to request an ALJ hearing after receiving a reconsideration determination?

120 days
180 days
90 days
60 days

The correct answer is: 60 days

The timeframe to request an Administrative Law Judge (ALJ) hearing after receiving a reconsideration determination is indeed 60 days. This specific timeline is established by the Centers for Medicare & Medicaid Services (CMS) guidelines, which dictate that beneficiaries or affected parties must file their written request for a hearing within 60 days from the date they receive notice of the reconsideration determination. Understanding this timeframe is crucial for healthcare providers and coders because it impacts the appeals process for denied claims. If a request for a hearing is not made within this 60-day window, the opportunity to contest the reconsideration decision is forfeited, solidifying the original determination. The other timeframes presented are longer than what is stipulated by CMS and are not applicable to the request for an ALJ hearing in this context. Recognizing the correct timeframe is essential for ensuring compliance with proper appeal procedures in healthcare coding and billing practices.