Notice: This CMS-approved document has been submitted - Philips ...

CMS-1403-FC
numbers to providers and suppliers participating in the
Medicare program. However, Medicare contractors do convey
billing privileges to providers and suppliers that have an
NPI and meet all of the program requirements for their
provider or supplier type. Once enrolled, providers and
suppliers are required to use their NPI to submit claims to
Medicare, and based on the NPI final rule, organizations
may obtain one or more NPIs.
After reviewing public comments, we are finalizing the
provisions at §424.530(a)(6) and (a)(7) to deny enrollment
applications for additional Medicare billing privileges if
a physician, NPP, physician or NPP organization has an
existing payment suspension or has an existing overpayment
that has not been repaid. We believe that permitting a
Medicare contractor to deny enrollment applications
submitted by individual practitioners, authorized
officials, delegated officials, and owners until such time
as the Medicare overpayment has been repaid in full will
require providers and suppliers to resolve overpayments in
a timely manner. Once CMS has imposed a payment
suspension, a provider or supplier may submit a rebuttal to
CMS for the purpose of reducing or terminating the payment
suspension. As long as the payment suspension is effective,
the contractor has the task of making an overpayment
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