Fed Regist. 2008 Jun 27;73(125):36448-63.
This final rule implements a number of regulatory provisions that are applicable to all providers and suppliers, including durable medical equipment, prosthetics, orthotics, and supplies (DMEPOS) suppliers. This final rule establishes appeals processes for all providers and suppliers whose enrollment, reenrollment or revalidation application for Medicare billing privileges is denied and whose Medicare billing privileges are revoked. It also establishes timeframes for deciding enrollment appeals by an Administrative Law Judge (ALJ) within the Department of Health and Human Services (DHHS) or the Departmental Appeals Board (DAB), or Board, within the DHHS; and processing timeframes for CMS' Medicare fee-for-service (FFS) contractors. In addition, this final rule allows Medicare FFS contractors to revoke Medicare billing privileges when a provider or supplier submits a claim or claims for services that could not have been furnished to a beneficiary. This final rule also specifies that a Medicare contractor may establish a Medicare enrollment bar for any provider or supplier whose billing privileges have been revoked. Lastly, the final rule requires that all providers and suppliers receive Medicare payments by electronic funds transfer (EFT) if the provider or supplier, is submitting an initial enrollment application to Medicare, changing their enrollment information, revalidating or re-enrolling in the Medicare program.
本最终规则实施了多项适用于所有医疗服务提供者和供应商的监管规定，包括耐用医疗设备、假肢、矫形器及用品（DMEPOS）供应商。本最终规则为所有其医疗保险计费特权的注册、重新注册或重新验证申请被拒以及医疗保险计费特权被撤销的医疗服务提供者和供应商设立了上诉程序。它还规定了由美国卫生与公众服务部（DHHS）内的行政法法官（ALJ）或DHHS内的部门上诉委员会（DAB）或委员会决定注册上诉的时间框架；以及医疗保险和医疗补助服务中心（CMS）的医疗保险按服务收费（FFS）承包商的处理时间框架。此外，本最终规则允许医疗保险FFS承包商在医疗服务提供者或供应商提交本不可能提供给受益人的一项或多项服务的索赔时撤销医疗保险计费特权。本最终规则还规定，医疗保险承包商可为其计费特权已被撤销的任何医疗服务提供者或供应商设立医疗保险注册限制。最后，最终规则要求，如果医疗服务提供者或供应商正在向医疗保险提交初始注册申请、更改其注册信息、重新验证或重新加入医疗保险计划，则所有医疗服务提供者和供应商都必须通过电子资金转账（EFT）方式接收医疗保险付款。
