Deactivation of Billing Privileges/Suspension of Payment

Table of Contents

• Reasons for Deactivation of Medicare Billing Privileges/Suspension of Payment (not all inclusive)
  • Inactivity
  • Failure to Complete Revalidation within Required Time Frame
  • Unreported provider address or bank information
  • Removal of a DNF Initiative from the Enrollment
  • Reactivation of Billing Privileges
• Related Content

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Reasons for Deactivation of Medicare Billing Privileges/Suspension of Payment (not all inclusive)

• Inactivity
• Failure to complete revalidation within required time frame
• Unreported provider address and/or bank information

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Inactivity

Medicare will routinely deactivate the billing privileges of those providers who fail to bill the Medicare Program for twelve consecutive months. Each billing account is considered separately for the deactivation criteria. This means that a provider who is affiliated with multiple Medicare Identification Numbers, only the Medicare Identification Number that has not billed will be deactivated. Notification is not done prior to deactivation.

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Failure to Complete Revalidation within Required Time Frame

Providers who fail to complete the required revalidation process within 60 days of the date of the revalidation letter from their MAC risk deactivation of Medicare billing privileges.

If the application for revalidation was sent and additional information is required, the contact on the application will be notified and has 30 days to respond. If failure to respond timely to the request, the Medicare enrollment will be deactivated.

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Unreported provider address or bank information

All Medicare providers are responsible for providing their Medicare contractor with their current and accurate mailing address and bank information as indicated in “Time Requirements to Notify Medicare of Changes”

The contractor shall follow the DNF initiative instructions in CMS IOM Publication 100-04, Medicare Claims Processing Manual, Chapter 1, Section 80.5. Returned paper checks, remittance notices, or EFT payments shall be flagged if returned from the post office or banking institution, respectively, as this may indicate that the provider’s “special payment” address (section 4 of the Form CMS-855A) or EFT information has changed.

It is important to notify Medicare in advance of your address and/or banking change. This will help you avoid the hassles of a DNF and a delay in your payments. Any address and/or bank changes received in advance of 60 days will be returned.

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Removal of a DNF Initiative from the Enrollment

Under the DNF initiative, you as a provider are required to update all addresses and/or bank information before the Medicare contractor can remove the DNF.

You will need to submit appropriate CMS-855 to the Medicare contractor with the correct section completed to change your address(es) and/or CMS-588 with correct bank information; however, both actions can be submitted electronically via PECOS. Submit a copy of a voided check or bank confirmation letter with the CMS-588.

Once this has been done and all addresses or bank information have been verified, Medicare will remove the DNF. From that point we will release any payments that were on hold due to the DNF. Any remittance notice that has been held can be requested by the provider through the NGSConnex or IVR system.

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Reactivation of Billing Privileges

Pursuant to 42 CFR, Section 424.545(b), a provider or supplier whose Medicare billing privileges have been deactivated may file a rebuttal in accordance with 42 CFR, Section 405.374 for further information see Rebuttal for Deactivation of Medicare Billing Privileges.

Otherwise, to reactivate enrollment billing privileges submit a completed CMS-855A and CMS-588 paper application or submit electronically via PECOS. Submit a copy of a voided check or bank confirmation letter with the CMS-588.

Critical Access Hospital will complete the CMS-855R for each reassignment except when the hospital was deactivated due to revalidation nonresponse.

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Related Content

• The Centers for Medicare & Medicaid Services Internet-Only Manuals
  • Publication 100-04, Medicare Claims Processing Manual, Chapter 1, Section 80.5
  • Publication 100-08, Medicare Program Integrity Manual, Chapter 15
  • Publication 100-08, Medicare Program Integrity Manual, Chapter 10