42 CFR 512.660 - Appeals process.

Regulations last checked for updates: Oct 26, 2026

Title 42 - Public Health last revised: Oct 13, 2026

View all text of Subpart F [§ 512.600 - § 512.695]

§ 512.660 - Appeals process.

(a) General. Subject to the limitations on review in § 512.170, the CJR-X participant may submit a notice of calculation error for one or more calculations involving a matter related to payment, reconciliation payment amounts, repayment amounts, the use of quality measure results in determining the composite quality score, or the application of the composite quality score during reconciliation.

(b) Requirements.

(1) If the CJR-X participant identifies a calculation error as described in paragraph (a) of this section, the CJR-X participant must submit written notice of the error, in a form and manner specified by CMS, within 30 days of the issuance of the reconciliation report.

(2) If the CJR-X participant does not provide timely written notice of calculation error, CMS deems the CJR-X reconciliation report to be final 30 days after it is issued and proceeds with the payment or repayment processes as applicable.

(3) Only CJR-X participants may use this calculation error process.

(1) If CMS determines the timely error notice meets the requirements of this section and contains sufficient information to substantiate the request, CMS issues an initial determination in writing within 30 days of receipt to either confirm that there was an error in the calculation or verify that the calculation is correct.

(2) CMS reserves the right to extend the time for providing its initial final determination upon written notice to the CJR-X participant.

(3) If the request is not compliant with the requirements of this section or requires additional information—

(i) CMS contacts the CJR-X participant to request additional information in a form and manner as specified by CMS;

(ii) The CJR-X participant must respond within 10 days of CMS' request for additional information in a form and manner as specified by CMS; and

(iii) If a CJR-X participant does not respond in accordance with paragraph (c)(3)(ii) of this section, then the reconciliation report is deemed final.

(d) Reconsideration request. A CJR-X participant who wishes to dispute an initial determination made in accordance with paragraph (c) of this section may invoke the reconsideration review process under § 512.190.

authority: 42 U.S.C. 1302,1315a,and

source: 85 FR 61362, Sept. 29, 2020, unless otherwise noted.

cite as: 42 CFR 512.660