§ 405.800 Appeals of CMS or a CMS contractor.

A CMS contractor's (that is, a carrier, Fiscal Intermediary or Medicare Administrative Contractor (MAC)) determination that a provider or supplier fails to meet the requirements for Medicare billing privileges. (a) Denial of a provider or supplier enrollment application. If CMS or a CMS contractor denies a provider's or supplier's enrollment application, CMS or the CMS contractor notifies the provider or supplier by certified mail. The notice includes the following: (1) The reason for the denial in sufficient detail to allow the provider or supplier to understand the nature of its deficiencies. (2) The right to appeal in accordance with part 498 of this chapter. (3) The address to which the written appeal must be mailed. (b) Revocation of Medicare billing privileges—(1) Notice of revocation. If CMS or a CMS contractor revokes a provider's or supplier's Medicare billing privileges, CMS or a CMS contractor notifies the supplier by certified mail. The notice must include the following: (i) The reason for the revocation in sufficient detail for the provider or supplier to understand the nature of its deficiencies. (ii) The right to appeal in accordance with part 498 of this chapter. (iii) The address to which the written appeal must be mailed. (2) Effective date of revocation. The effective date of a revocation is as specified in § 424.535 of this chapter. (3) Payment after revocation. Medicare does not pay, and the CMS contractor rejects, claims for services submitted with a service date on or after the effective date of a provider's or supplier's revocation. (c) Additional years applied to a reenrollment bar. (1) If, under § 424.535(c)(2)(i) of this chapter, CMS or a CMS contractor applies additional years to a provider's or supplier's existing reenrollment bar, CMS or the CMS contractor notifies the provider or supplier by certified mail. The notice includes the following: (i) The reason for the application of additional years in sufficient detail to allow the provider or supplier to understand the nature of the action. (ii) The right to appeal in accordance with part 498 of this chapter. (iii) The address to which the written appeal must be mailed. (2) Paragraph (c)(1) of this section applies only to the years added to the existing reenrollment bar under § 424.535(c)(2)(i) of this chapter and not to the original length of the reenrollment bar, which is not subject to appeal. (d) Scope of supplier. For purposes of this subpart, the term “supplier” includes all of the following: (1) The individuals and entities that qualify as suppliers under § 400.202 of this chapter. (2) Physical therapists in private practice. (3) Occupational therapists in private practice. (4) Speech-language pathologists.