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

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

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19.02.2013 Views

CMS-1403-FC or supplier’s billing privileges is effective 30 days after CMS or the CMS contractor mails notice of its determination to the provider or supplier. A revocation based on Federal exclusion or debarment is effective with the date of the exclusion or debarment.” During the 30 days after CMS or our contractor mails a revocation notice to a provider or supplier, the provider or supplier is afforded the opportunity to submit a corrective action plan. A corrective action plan gives a provider or supplier an opportunity to provide evidence that demonstrates that the provider or supplier is in compliance with Medicare requirements. Moreover, a provider or supplier can use a corrective action plan to correct the deficiency without filing an appeal under 42 CFR part 498, and remain in the Medicare program when the provider demonstrates that the provider or supplier is in compliance with Medicare requirements and the Medicare contractor accepts the corrective action plan. In those situations where a provider or supplier submits an acceptable corrective action plan, the provider or supplier maintains their billing privileges and the revocation determination is not implemented. We maintain that providers or suppliers are able to provide sufficient evidence through a corrective action 776

CMS-1403-FC plan that demonstrates that they are in compliance with Medicare requirements when CMS or our contractor imposes a revocation based on certain types of adverse actions such as a Federal exclusion or debarment. Accordingly, consistent with revoking billing privileges with the date of exclusion or debarment, we believe that similarly situated revocations such as felony convictions and license suspension or revocation do not lend themselves to a corrective action plan and that the revocation should be effective with the date of the felony conviction or the license suspension or revocation. Moreover, we maintain that when CMS or our contractor determines that a provider or supplier, including a DMEPOS supplier, is no longer operating at the practice location provided to Medicare on a paper or electronic Medicare enrollment application that the revocation should be effective with the date that CMS or our contractor determines that the provider or supplier is no longer operating at the practice location. Further, while we do not believe that revocations based on felony convictions, license suspension or revocation, or a revocation based on a provider or a supplier no longer being operational at a specific practice location, lend themselves to a corrective action plan, we believe that these providers and suppliers should be 777

<strong>CMS</strong>-1403-FC<br />

plan that demonstrates that they are in compliance with<br />

Medicare requirements when <strong>CMS</strong> or our contractor imposes a<br />

revocation based on certain types of adverse actions such<br />

as a Federal exclusion or debarment. Accordingly,<br />

consistent with revoking billing privileges with the date<br />

of exclusion or debarment, we believe that similarly<br />

situated revocations such as felony convictions and license<br />

suspension or revocation do not lend themselves to a<br />

corrective action plan and that the revocation should be<br />

effective with the date of the felony conviction or the<br />

license suspension or revocation. Moreover, we maintain<br />

that when <strong>CMS</strong> or our contractor determines that a provider<br />

or supplier, including a DMEPOS supplier, is no longer<br />

operating at the practice location provided to Medicare on<br />

a paper or electronic Medicare enrollment application that<br />

the revocation should be effective with the date that <strong>CMS</strong><br />

or our contractor determines that the provider or supplier<br />

is no longer operating at the practice location.<br />

Further, while we do not believe that revocations<br />

based on felony convictions, license suspension or<br />

revocation, or a revocation based on a provider or a<br />

supplier no longer being operational at a specific practice<br />

location, lend themselves to a corrective action plan, we<br />

believe that these providers and suppliers should be<br />

777

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