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19.02.2013 Views

CMS-1403-FC Response: We are not adopting this recommendation. Instead, we will respond to the specific comments received in response to our specific proposals. Comment: Several commenters requested that we make no revisions to current physician and NPP enrollment rules at this time. Response: We are not adopting this recommendation. Instead, we will respond to the specific comments received in response to our specific proposals. After reviewing public comments, we are finalizing the provisions found at §424.535(h) (formerly §424.535(g)) that require a revoked physician organization, a physician, a NPP, or an IDTF to submit all outstanding claims not previously submitted within 60 calendar days of the revocation effective date. Since IDTFs are already afforded approximately 30 days notification before the effective date of revocation (except for revocations identified in §405.874(b)(2) and §424.535(f) of this final rule), we believe that almost 90 days is more than sufficient time to file any outstanding claims. In addition, we are finalizing the provisions found at §424.44(a) related to the requirements for the timely filing of claims. The timely filing requirements in §424.44(a)(1) and (a)(2) will no longer apply to physician 222

CMS-1403-FC and NPP organizations, physicians, NPPs or IDTFs. We revised this provision so that it is consistent with §424.521 which limits the ability of these suppliers to bill Medicare retrospectively. J. Physician and Nonphysician Practitioner (NPP) Enrollment Issues 1. Effective Date of Medicare Billing Privileges In accordance with §424.510, physician and NPP organizations (that is, groups, clinics, and sole owners) and individual practitioners including physicians and NPPs, operating as sole proprietorships or reassigning their benefits to a physician and nonphysician organization may submit claims as specified in §424.44 after they are enrolled in the Medicare program. This provision permits newly enrolled physician and NPP organizations and individual practitioners, as well as existing physicians and nonphysician organizations and individual practitioners to submit claims for services that were furnished prior to the date of filing or the date the applicant received billing privileges to participate in the Medicare program. For the purposes of this final rule with comment period, we believe that an NPP includes, but is not limited to, the following individuals: anesthesiology assistants, audiologists, certified nurse midwives, certified 223

<strong>CMS</strong>-1403-FC<br />

Response: We are not adopting this recommendation.<br />

Instead, we will respond to the specific comments received<br />

in response to our specific proposals.<br />

Comment: Several commenters requested that we make no<br />

revisions to current physician and NPP enrollment rules at<br />

this time.<br />

Response: We are not adopting this recommendation.<br />

Instead, we will respond to the specific comments received<br />

in response to our specific proposals.<br />

After reviewing public comments, we are finalizing the<br />

provisions found at §424.535(h) (formerly §424.535(g)) that<br />

require a revoked physician organization, a physician, a<br />

NPP, or an IDTF to submit all outstanding claims not<br />

previously <strong>submitted</strong> within 60 calendar days of the<br />

revocation effective date. Since IDTFs are already<br />

afforded approximately 30 days notification before the<br />

effective date of revocation (except for revocations<br />

identified in §405.874(b)(2) and §424.535(f) of this final<br />

rule), we believe that almost 90 days is more than<br />

sufficient time to file any outstanding claims.<br />

In addition, we are finalizing the provisions found at<br />

§424.44(a) related to the requirements for the timely<br />

filing of claims. The timely filing requirements in<br />

§424.44(a)(1) and (a)(2) will no longer apply to physician<br />

222

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