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

CMS-1403-FC
Response: Based on these comments, we are adding a
definition of a final adverse action to §424.502(a).
Specifically, we have defined a final adverse action to
mean one or more of the following actions: (1) A
Medicare-imposed revocation of any Medicare billing
privileges; (2) Suspension or revocation of a license to
provide health care by any State licensing authority; (3)
Revocation or suspension by an accreditation organization;
(4) A conviction of a Federal or State felony offense (as
defined in §424.535(a)(3)(i)) within the last 10 years
preceding enrollment, revalidation, or re-enrollment; or
(5) An exclusion or debarment from participation in a
Federal or State health care program.
Comment: One commenter suggested that we should
clarify in the final rule that with regard to adverse legal
actions, the requirements should apply only to notification
within 30 days of “final” legal actions that are relevant
to or otherwise impact the practice of medicine.
Response: While we understand that physicians and
NPPs are afforded different appeal rights depending on the
type of final adverse action, we do not believe that it is
appropriate to allow physicians and NPPs to continue to
furnish services to Medicare beneficiaries if their State
medical license has been suspended or revoked, a Federal
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