Home Health

New change request outlines rebuttal process for providers with deactivated Medicare billing

CMS has issued a change request outlining the rebuttal process for providers or suppliers whose Medicare billing has been deactivated.

CR 10978 provides instruction to Medicare Administrative Contractors (MACs) to advise providers of rebuttal rights and how to receive and process rebuttals. The change request takes effect Dec. 31, 2019.

Providers can submit a rebuttal request if deactivated for one of the following reasons:

  1. The provider or supplier does not submit any Medicare claims for 12 consecutive calendar months.
  2. The provider or supplier does not report a change to the information supplied on the enrollment application within 90 calendar days of when the change occurred. Changes that must be reported include, but are not limited to, a change in practice location, a change of any managing employee, and a change in billing services. A change in ownership or control must be reported within 30 calendar days.
  3. The provider or supplier does not furnish complete and accurate information and all supporting documentation within 90 calendar days of receipt of notification from CMS to submit an enrollment application and supporting documentation or resubmit and certify to the accuracy of its enrollment information.

Requirements for a rebuttal submission include:

  1. Must be received by the contractor within 20 calendar days from the date of the deactivation notice. The contractor shall accept a rebuttal submission via hard-copy mail, email, and/or fax;
  2. Must specify the facts or issues with which the provider or supplier disagrees, and the reasons for disagreement;
  3. Should include all documentation and information the provider or supplier would like to be considered in reviewing the deactivation;
  4. Must be submitted in the form of a letter that is signed and dated by the individual provider, supplier, the authorized or delegated official, or a legal representative, as defined in 42 C.F.R. § 498.10. If the legal representative is an attorney, the attorney must include a statement that he or she has the authority to represent the provider or supplier. This statement is sufficient to constitute notice. If the legal representative is not an attorney, the provider or supplier must file written notice of the appointment of a representative with the contractor. This notice of appointment must be signed and dated by the individual provider or supplier, the authorized or delegated official, or a legal representative.

Related link: View the change request at https://go.cms.gov/35holIw.