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

CMS-1403-FC
practitioners, including physicians and NPPs, must submit
all outstanding claims not previously submitted within
30 calendar days of the revocation effective date. We
stated that this change is necessary to limit the Medicare
program’s exposure to future vulnerabilities from physician
and NPP organizations and individual practitioners that
have had their billing privileges revoked. We know that
some physician and NPP organizations and individual
practitioners are able to create false documentation to
support claims payment. Accordingly, we stated that the
proposed change would allow a Medicare contractor to
conduct focused medical review on the claims submitted
during the claims filing period to ensure that each claim
is supported by medical documentation that the contractor
can verify. We also stated that focused medical review of
these claims will ensure that Medicare only pays for
furnished services by a physician organization or
individual practitioner and that these entities and
individuals receive payment in a timely manner. Since a
physician organization or individual practitioner generally
submits claims on a nexus to the date of service, we stated
that the proposed change will not impose a significant
burden on physician organizations or individual
practitioners. In addition, we also proposed to add
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