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Submitting a provider enrollment rebuttal
Last Modified: 7/19/2024
Location: FL, PR, USVI
Business: Part A, Part B
A provider or supplier whose Medicare billing privileges have been deactivated may file a rebuttal. 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.
A rebuttal may be submitted for the following deactivation reasons:
• The provider or supplier does not submit any Medicare claims for 12 consecutive calendar months.
• The provider or supplier does not report a change to the information supplied on the enrollment application within the applicable time period required under Title 42. (For example, a provider or supplier type falling within the purview of § 424.516(e)(1) and (2) failed to report a change in ownership or control within (i) 30 calendar days of when the change occurred, or (b) 90 calendar days of when the change occurred for all other information on the enrollment application.)
• 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.
• The provider or supplier is not in compliance with all enrollment requirements.
• The provider's or supplier's practice location is non-operational or otherwise invalid.
• The provider or supplier is deceased.
• The provider or supplier is voluntarily withdrawing from Medicare.
• The provider is the seller in an HHA change of ownership § 424.550(b)(1).
You will receive a deactivation notice detailing why the enrollment file has been deactivated and your ability to rebut, if the file was deactivated for one of the above reasons. Please be aware that your Medicare payments will stop upon deactivation. The hard copy deactivation notice will be provided via mail and email, if an email address is available. A rebuttal coversheet will be included with your deactivation notice.
If you believe the deactivation determination is incorrect, you can rebut the decision. The rebuttal must be submitted in the form of a letter and received by First Coast, in writing, within 15 calendar days from the deactivation letter date. Only one rebuttal request may be submitted per deactivation.
Note: Rebuttal requests received after 15 calendar days from the deactivation letter date will be dismissed.
The rebuttal submission must:
• Be in writing;
• Specify the facts or issues concerning the rebuttal with which the provider or supplier disagrees, and the reasons for disagreement;
• Include all documentation the provider or supplier wants CMS to consider in its review of the deactivation;
• Be submitted in the form of a letter that is signed and dated by the individual supplier (if enrolled as an individual physician or nonphysician practitioner), the authorized official or delegated official (as those terms are defined in 42 CFR 424.502), 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 he, she, or they have the authority to represent the provider or supplier; this statement is sufficient to constitute notice of such authority.
• If the legal representative is not an attorney, the provider or supplier must file with CMS written notice of the appointment or a representative; this notice of appointment must be signed and dated by, as applicable, the individual supplier, the authorized official or delegated official, or a legal representative.
• Authorized or delegated officials for groups cannot sign and submit a rebuttal on behalf of a reassigned provider or supplier without the provider or supplier submitting a signed statement authorizing that individual from the group to act on his, her, or their behalf.
• Signatures may be original or electronic. Valid signatures include handwriting (wet) signatures in ink and digital/electronic signatures. Digital or electronic signatures such as those created by digital signature options, created in software, such as Adobe, and email signatures shall be accepted.
Be received by the contractor within 15 calendar days from the date of the deactivation notice. The contractor shall accept a rebuttal submission via hard-copy mail, e-mail, and/or fax.
Note: We ask that you include the rebuttal coversheet with your submission.
The options for submitting a rebuttal are listed below.
Fax:
904-361-0737
Email:
Mail:
First Coast Service Options, Inc.
P.O. Box 3409
Mechanicsburg, PA 17055-1849
Once the rebuttal is received and accepted, a decision will be issued within 30 calendar days of the date of receipt. The rebuttal decision will be provided hard copy via mail and email, if an email address is available.
If you were deactivated for one of the reasons above and the rebuttal decision is unfavorable, you must revalidate/reactivate your Medicare enrollment record to recover your billing privileges. There are two ways to complete the revalidation/reactivation application:
If you have any questions, please contact our office at 888-845-8614.
First Coast Service Options (First Coast) strives to ensure that the information available on our provider website is accurate, detailed, and current. Therefore, this is a dynamic site and its content changes daily. It is best to access the site to ensure you have the most current information rather than printing articles or forms that may become obsolete without notice.
