[Title 42 CFR 424.540]
[Code of Federal Regulations (annual edition) - October 1, 2007 Edition]
[Title 42 - PUBLIC HEALTH]
[Chapter IV - CENTERS FOR MEDICARE]
[Subchapter A - GENERAL PROVISIONS]
[Part 424 - CONDITIONS FOR MEDICARE PAYMENT]
[Subpart P - Requirements for Establishing and Maintaining Medicare Billing]
[Sec. 424.540 - Deactivation of Medicare billing privileges.]
[From the U.S. Government Printing Office]


42PUBLIC HEALTH32007-10-012007-10-01false424.540Sec. 424.540PUBLIC HEALTHCENTERS FOR MEDICAREGENERAL PROVISIONSCONDITIONS FOR MEDICARE PAYMENTRequirements for Establishing and Maintaining Medicare Billing
Sec. 424.540  Deactivation of Medicare billing privileges.

    (a) Reasons for deactivation. CMS may deactivate a provider or 
supplier's Medicare billing privileges for the following reasons:

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    (1) The provider or supplier does not submit any Medicare claims for 
12 consecutive calendar months. The 12 month period will begin the 1st 
day of the 1st month without a claims submission through the last day of 
the 12th month without a submitted claim.
    (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 Sec. 424.520(b) and Sec. 424.550(b).
    (b) Reactivation of billing privileges. (1) When deactivated for any 
reason other than nonsubmission of a claim, the provider or supplier 
must complete and submit a new enrollment application to reactivate its 
Medicare billing privileges or, when deemed appropriate, at a minimum, 
recertify that the enrollment information currently on file with 
Medicare is correct.
    (2) Providers and suppliers deactivated for nonsubmission of a claim 
are required to recertify that the enrollment information currently on 
file with Medicare is correct and furnish any missing information as 
appropriate. The provider or supplier must meet all current Medicare 
requirements in place at the time of reactivation, and be prepared to 
submit a valid Medicare claim.
    (3) Reactivation of Medicare billing privileges does not require a 
new certification of the provider or supplier by the State survey agency 
or the establishment of a new provider agreement.
    (c) Effect of deactivation. Deactivation of Medicare billing 
privileges is considered an action to protect the provider or supplier 
from misuse of its billing number and to protect the Medicare Trust 
Funds from unnecessary overpayments. The deactivation of Medicare 
billing privileges does not have any effect on a provider or supplier's 
participation agreement or any conditions of participation.