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

CMS-1403-FC
After reviewing public comments, we are finalizing the
provision at proposed §424.516(d) which would require
physicians, NPPs or physician and NPP organizations to
notify its Medicare contractor of a change of ownership,
change in practice location or any final adverse action
within 30 days of the reportable event. In addition, we
believe that physician and NPP organizations’ and
individual practitioners’ failure to comply with the
reporting requirements within the time frame described
above may result in the revocation of Medicare billing
privileges and the imposition of a Medicare overpayment
from the date of the reportable change. Specifically, we
believe that a final adverse action may preclude payment,
and thus, establish an overpayment from the date of the
adverse legal action. As such, we believe that physician
and NPP organizations and individual practitioners should
not be allowed to retain any reimbursement they receive
after the date of the adverse legal action. In addition,
physicians, NPPs, or physician and NPP organizations who
voluntarily report a final adverse action that prohibits
further payment will have their Medicare billing privileges
revoked and have an overpayment assessed back to the date
of the reportable event. CMS has the discretion to revoke
the supplier’s billing privileges. Moreover, revocation
306