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 ...
CMS-1403-FC determined that the provider or supplier was no longer operational.” We believe that these changes will ensure that providers and suppliers are afforded due process rights under 42 CFR part 498, but also ensure that Medicare is not making or continuing to make payments to providers and suppliers who are no longer eligible to receive payments. We solicited comments on whether we should establish an expedited reconsideration process for providers and suppliers for when we issue a revocation for the following reasons: (1) Federal debarment or exclusion, (2) felony conviction, (3) license suspension or revocation, or (4) when CMS or our contractor determines that the provider is not operational at the practice location provided to Medicare and the provider or supplier furnishes sufficient evidence to demonstrate that CMS or our contractor made a factual error when issuing the initial revocation determination. In addition, we solicited comments on whether CMS or our contractors should consider processing expedited reconsiderations within a specified time period such as 30 days of the date the provider or supplier furnishes sufficient evidence to make a reconsideration determination. 780
CMS-1403-FC The following is a summary of the comments we received and our responses. Comment: Several commenters recommended that we withdraw our proposed changes to the appeals process. Response: We disagree with these commenters because we continue to believe that we should not make further payments to physicians and NPPs who have had their State medical license suspended or revoked, were convicted of a felony as described in §424.535(a)(3), were excluded or debarred from participating in a Federal program, or were determined by CMS or its contractor not to be operational. Comment: One commenter urged CMS to require contractors to send revocation notices in an effective manner that would establish a date of receipt and the recipient. Response: While this comment is outside the scope of the proposed rule, Medicare contractors are instructed to mail revocation notices to the correspondence address of the provider. Comment: One commenter recommended that we create an expedited reconsideration process of not more than 30 days in cases where revocation is based on CMS/contractor error. Response: While we have considered establishing an expedited reconsideration process for those cases in which 781
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<strong>CMS</strong>-1403-FC<br />
determined that the provider or supplier was no longer<br />
operational.”<br />
We believe that these changes will ensure that<br />
providers and suppliers are afforded due process rights<br />
under 42 CFR part 498, but also ensure that Medicare is not<br />
making or continuing to make payments to providers and<br />
suppliers who are no longer eligible to receive payments.<br />
We solicited comments on whether we should establish<br />
an expedited reconsideration process for providers and<br />
suppliers for when we issue a revocation for the following<br />
reasons: (1) Federal debarment or exclusion, (2) felony<br />
conviction, (3) license suspension or revocation, or (4)<br />
when <strong>CMS</strong> or our contractor determines that the provider is<br />
not operational at the practice location provided to<br />
Medicare and the provider or supplier furnishes sufficient<br />
evidence to demonstrate that <strong>CMS</strong> or our contractor made a<br />
factual error when issuing the initial revocation<br />
determination.<br />
In addition, we solicited comments on whether <strong>CMS</strong> or<br />
our contractors should consider processing expedited<br />
reconsiderations within a specified time period such as 30<br />
days of the date the provider or supplier furnishes<br />
sufficient evidence to make a reconsideration<br />
determination.<br />
780
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