A Late Medicare Appeal Is Almost Never Excused. Your Billing Company's Delay Is Not an Excuse at All.

On October 8, CMS issued Change Request 14629. It rewrites sections 100 to 240.5 of Chapter 29, the appeals chapter of the Medicare Claims Processing Manual, from December 11, 2026. CMS says the policy is not changing. The rewrite is for clarity.

Clarity is the point. The new text tells Medicare Administrative Contractors (MACs) exactly how to treat an appeal that arrives late, and it is blunt about physician practices: a late request from a provider, physician or supplier "should not be routinely granted" and "warrants careful examination". Beneficiaries get more lenience. Practices do not.

The date that counts is the day the MAC receives it

A first-level appeal, called a redetermination, must be filed within 120 days of receiving the remittance advice. The notice is presumed received 5 days after its date. That part most billing teams know.

What the manual now spells out is how "filed" is measured. An appeal is filed when the right contractor receives it at the address on the notice: the date stamped in its mailroom, the date a fax arrives, or the date it lands in the MAC's portal. The postmark does not count. Nor does the date you handed it to a courier.

If the 120th day falls on a weekend or a federal holiday, the deadline rolls to the next working day. That is the only automatic extra time.

Two kinds of good cause for a practice

If the request is late, the MAC decides good cause before it looks at anything else. For a physician practice, the manual lists only two situations:

• Incorrect or incomplete information about the claim or the appeal came from an official source: CMS, the MAC or the Social Security Administration.
• Unavoidable circumstances beyond the practice's control, such as sustained widespread illness during a pandemic, or floods, fires, tornadoes and other natural disasters.

Then comes the sentence every practice that outsources billing should read. A billing company or consultant that failed to file appeals on time is not good cause. Neither is a claim that the business office lacked the management skill or expertise to file. The practice owns the deadline, whoever does the work.

What happens to a late appeal

If a late request has no explanation, or the explanation is not enough, the MAC dismisses it. The practice then has two routes: send the MAC an explanation of the late filing within 180 days of the dismissal notice and ask it to vacate the dismissal, or ask the Qualified Independent Contractor (QIC) to review the dismissal within 60 days of receiving it.

A request for more time must be in writing and must say why the appeal was late. Good cause at the first level does not carry forward. The 180-day clock for the next level still applies.

For a declared disaster, the rules are wider. A MAC grants temporary relief for up to 6 months, case by case, and stops recoupment on an overpayment appeal. Being in the disaster area is not enough on its own. The practice must state that it was affected.

Not every denial needs an appeal

The chapter also explains what is not an appeal at all. Three cases cost practices the most time:

• Clerical errors. A wrong modifier, a transposed date or a missed diagnosis pointer is a minor error or omission. Under 42 CFR 405.980, the MAC must handle it as a reopening, even if you sent it as an appeal. A practice may ask for a reopening within 1 year of the initial determination for any reason.
• Claims rejected for timely filing. A claim sent more than one year after the date of service is rejected, and a rejected claim has no appeal rights. If you believe it was on time, or meets an exception, the route is the MAC's timely filing review under Chapter 1, section 70.7.1, not an appeal.
• Resubmitted claims. A second claim for the same service gets no new appeal rights. The rights, and the clock, run from the first decision.

A check to run before December 11

This is general information, not legal advice. A practice can start here:

• List every Medicare denial still open and write the true deadline next to it: the remittance date plus 125 days, rolled to the next working day.
• Count back from the receipt date, not the mailing date. If you mail appeals, allow for delivery, or file through the MAC's portal or fax and keep the confirmation.
• Ask your biller for the date each appeal was received by the MAC, not the date it was sent.
• Sort open denials: clerical errors go to reopening, true disputes go to redetermination, and timely filing rejections go to the timely filing review.
• Check your billing contract. If your billing company misses an appeal date, Medicare will not excuse it, so find out who carries that loss.
• Keep every dismissal notice and diary the 60-day QIC date and the 180-day vacate date the day it arrives.
• If a disaster affects your office, put that statement in writing on every late request.

Medicare Advantage plans set their own first-level appeal rules. Check each plan's provider manual.

The deadline belongs to the practice

Most late Medicare appeals are not lost on the merits. They are lost in a queue, at a vendor or in the mail. The manual now says in plain words that none of those is an excuse. If you want a second view of which denied Medicare claims are still inside their window, a revenue review is a place to start.