Provider Enrollment Appeals and Rebuttal

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. The 12 month period will begin the 1st day and 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 the applicable time period required under this title.
  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.
  4. The provider or supplier is not in compliance with all enrollment requirements in this title.
  5. The provider’s or supplier’s practice location is non-operational or otherwise invalid.
  6. The provider or supplier is deceased.
  7. The provider or supplier is voluntarily withdrawing from Medicare.
  8. The provider is the seller in an HHA change of ownership under Section 424.550(b)(1).

In order to be considered, the rebuttal must:

  • be submitted on the rebuttal form (submission instructions on form);
  • be received within 15 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.

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Revised 7/22/2024