Rebuttal for Deactivation of Medicare 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.

A rebuttal is an opportunity for the provider or supplier to demonstrate that it meets all applicable enrollment requirements and that its Medicare billing privileges should not have been deactivated. Only one rebuttal request may be submitted per deactivation. Additional rebuttal requests shall be dismissed.

Providers and suppliers may submit a rebuttal request for the following deactivation reasons, in accordance with 42 CFR, Section 424.540(a):

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 as specified in Sections 424.520(b) and 424.550(b).
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.

In order to be considered, the rebuttal must:

• be submitted on the rebuttal form (submission instructions on form);
• be received within 20 calendar days of the date of deactivation notice;
• state the issues or findings of fact with which you disagree and the reasons for disagreement. You may submit additional information with the rebuttal that you believe may have a bearing on the decision and include any application(s) to update your enrollment, if necessary; and
• be signed and dated by the individual provider/supplier, the authorized or delegated official, or a legal representative.

Related Content

• Rebuttal Form located under Provider Resources on our website, select Forms
• Medicare Learning Matters publication MM10978 Provider Enrollment Rebuttal Process