All providers and suppliers, including durable medical equipment, prosthetics, orthotics, and supplies (DMEPOS) suppliers, will have the right to a hearing by an administrative law judge after they have received a denial or revocation of Medicare billing privileges. Timeframes have been established for appeal decisions issued by HHS administrative law judges, the Departmental Appeals Board, and CMS' Medicare fee-for-service (FFS) contractors.
Examples of appeals process
Medicare FFS contractors will be allowed to revoke Medicare billing privileges when a provider or supplier submits claims for services that could not have been furnished to a beneficiary on a specific date. For example, if the beneficiary is deceased, the directing physician or beneficiary is not in the state or country when services were furnished, or when the equipment necessary for testing is not present where the testing is said to have occurred. As well, a Medicare contractor may institute a Medicare enrollment bar for providers or suppliers who have had their billing privileges revoked. If a provider or supplier is submitting an initial enrollment application, changing enrollment information, revalidating or reenrolling in Medicare, then it must submit the form for receiving Medicare payments by electronic fund transfer. These regulations will become effective on August 26, 2008.
Source:
For more information on this and related topics, consult the CCH® Medicare and Medicaid Guide.
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