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CMS-1403-FC
retroactive to the date the change in practice location
occurred and may result in the revocation of Medicare
billing privileges. For example, if a physician and NPP
organization moves its practice location in New York, from
urban Herkimer County to Hamilton County or Lewis County,
which are both rural, but fails to update its provider
enrollment information; then it would no longer be able to
receive the higher payment rate associated with Herkimer
County. We believe that reporting these types of changes
is essential for making correct and appropriate payments.
We proposed to add §424.535(a)(9) which would specify
that failure to comply with the reporting requirements
specified in §424.516(d) would be a basis for revocation.
Additionally, we proposed in §424.565, “Failure to comply
with the reporting requirements specified in §424.516(d)
would result in a Medicare overpayment from the date of a
final adverse action or a change in practice location.” In
this situation, an overpayment for failure to timely report
these changes would be calculated back to the date of the
final adverse action or the date of the change in practice
location. Once an overpayment has been assessed, we will
follow the overpayment regulations established at 42 CFR
part 405 subpart C. We previously addressed these
procedures in Chapter 4 of the Medicare Financial
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