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Notice: This CMS-approved document has been submitted - Philips ... Notice: This CMS-approved document has been submitted - Philips ...
CMS-1403-FC existing overpayment at the time of filing of an enrollment application. (7) Payment suspension. The current owner (as defined in §424.502), physician or nonphysician practitioner has been placed under a Medicare payment suspension as defined in §405.370 through §405.372 of this subchapter. * * * * * 46. Section 424.535 is amended by-- A. Amending paragraph (a)(1) by removing the phrase “billing privileges.” and adding in its place “billing privileges, except for those imposed under paragraphs (a)(2), (a)(3), or (a)(5) of this section. B. Adding paragraphs (a)(9), (a)(10), and (h). C. Revising paragraph (g). The additions and revision read as follows: §424.535 Revocation of enrollment and billing privileges in the Medicare program. (a) * * * (9) Failure to report. The provider or supplier did not comply with the reporting requirements specified in §424.516(d)(1)(ii) and (iii) of this subpart. (10) Failure to document. The provider or supplier did not comply with the documentation requirements specified in §424.516(f) of this subpart. 1146
CMS-1403-FC * * * * * (g) Effective date of revocation. Revocation becomes effective 30 days after CMS or the CMS contractor mails notice of its determination to the provider or supplier, except if the revocation is based on Federal exclusion or debarment, felony conviction, license suspension or revocation, or the practice location is determined by CMS or its contractor not to be operational. When a revocation is based on a Federal exclusion or debarment, felony conviction, license suspension or revocation, or the practice location is determined by CMS or its contractor not to be operational, the revocation is effective with the date of exclusion or debarment, felony conviction, license suspension or revocation or the date that CMS or its contractor determined that the provider or supplier was no longer operational. (h) Submission of claims for services furnished before revocation. A physician organization, physician, nonphysician practitioner or independent diagnostic testing facility must submit all claims for items and services furnished within 60 calendar days of the effective date of revocation. 47. Section 424.565 is added to read as follows: §424.565 Overpayment. 1147
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<strong>CMS</strong>-1403-FC<br />
* * * * *<br />
(g) Effective date of revocation. Revocation becomes<br />
effective 30 days after <strong>CMS</strong> or the <strong>CMS</strong> contractor mails<br />
notice of its determination to the provider or supplier,<br />
except if the revocation is based on Federal exclusion or<br />
debarment, felony conviction, license suspension or<br />
revocation, or the practice location is determined by <strong>CMS</strong><br />
or its contractor not to be operational. When a revocation<br />
is based on a Federal exclusion or debarment, felony<br />
conviction, license suspension or revocation, or the<br />
practice location is determined by <strong>CMS</strong> or its contractor<br />
not to be operational, the revocation is effective with the<br />
date of exclusion or debarment, felony conviction, license<br />
suspension or revocation or the date that <strong>CMS</strong> or its<br />
contractor determined that the provider or supplier was no<br />
longer operational.<br />
(h) Submission of claims for services furnished before<br />
revocation. A physician organization, physician,<br />
nonphysician practitioner or independent diagnostic testing<br />
facility must submit all claims for items and services<br />
furnished within 60 calendar days of the effective date of<br />
revocation.<br />
47. Section 424.565 is added to read as follows:<br />
§424.565 Overpayment.<br />
1147