Chelsea Browning, APRN, DAB CR5720 (2020)

DECISION

Petitioner, Chelsea Browning, APRN, is a nurse practitioner, licensed to practice in Kentucky. She applied to enroll in the Medicare program and to reassign her billing privileges to the regional health department that employed her. The Centers for Medicare & Medicaid Services (CMS) granted her applications with a retrospective billing date of February 8, 2018 (and, by inference, an effective date of February 12, 2018). Petitioner now challenges that effective date.

Because Petitioner filed her subsequently-approved enrollment application on February 12, 2018, I find that February 12 is the correct effective date of her enrollment. Howard M. Sokoloff, DPM, MS, Inc., DAB No. 2972 (2019); Urology Grp. of NJ, LLC, DAB No. 2860 (2018); Willie Goffney, Jr., M.D., DAB No. 2763 at 7 (2017), aff’d sub nom. Goffney v. Azar, No. CV 17-8032 MRW (C.D. Cal. Sept. 25, 2019).

Background

In a letter dated March 27, 2018, the Medicare contractor, CGS, advised Petitioner Browning that it approved her Medicare enrollment with an “effective date” of February

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8, 2018. CMS Ex. 11. In fact, as explained below, the contractor was granting Petitioner a billing date of February 8, 2018; the effective date of Petitioner’s enrollment was February 12, 2018 (see discussion below). Petitioner sought reconsideration, asking that the effective date of her enrollment be “backdated” to September 1, 2017. CMS Ex. 12.

In a reconsidered determination, dated April 16, 2018, a contractor hearing officer denied Petitioner the earlier effective date, concluding (in error) that February 8 was the correct effective date. In fact, February 8 was a retrospective billing date. CMS Ex. 13.

Petitioner appealed.

CMS moves for summary judgment.

With its motion and brief (CMS Br.), CMS submits 14 exhibits (CMS Exs. 1-14). With her brief (P. Br.), Petitioner submits 22 exhibits (P. Exs. 1-22).1

Discussion

CMS is entitled to summary judgment because the undisputed evidence establishes that Petitioner filed her subsequently-approved enrollment applications on February 12, 2018, and her Medicare enrollment can be no earlier than that date. 42 C.F.R. § 424.520(d).2

Summary judgment. Summary judgment is appropriate when, as here, the case presents no genuine issue of material fact and the moving party is entitled to judgment as a matter of law. Donald W. Hayes, D.P.M., DAB No. 2862 at 8 (2018); 1866ICPayday.com, L.L.C., DAB No. 2289 at 2-3 (2009); Ill. Knights Templar Home, DAB No. 2274 at 3-4 (2009), and cases cited therein.

Enrollment. Petitioner Browning participates in the Medicare program as a “supplier” of services. Social Security Act § 1861(d); 42 C.F.R. § 498.2. To receive Medicare

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payments for the services furnished to program beneficiaries, a prospective supplier must enroll in the program. 42 C.F.R. § 424.505. “Enrollment” is the process by which CMS and its contractors: 1) identify the prospective supplier; 2) validate the supplier’s eligibility to provide items or services to Medicare beneficiaries; 3) identify and confirm a supplier’s owners and practice location; and 4) grant the supplier Medicare billing privileges. 42 C.F.R. § 424.502.

To enroll, a prospective supplier must complete and submit an enrollment application. 42 C.F.R. §§  424.510(d)(1), 424.515(a). An enrollment application is either a CMS-approved paper application or an electronic process approved by the Office of Management and Budget. 42 C.F.R. § 424.502.3 When CMS determines that a prospective supplier meets the applicable enrollment requirements, it grants Medicare billing privileges, which means that the supplier can submit claims and receive payments from Medicare for covered services provided to program beneficiaries. The effective date for its billing privileges “is the later of the date of filing” a subsequently-approved enrollment application or the date that the supplier first began furnishing services at a new practice location. 42 C.F.R. § 424.520(d) (emphasis added).

If a non-physician practitioner meets all program requirements, CMS may allow it to bill retrospectively for up to 30 days prior to the effective date “if circumstances precluded enrollment in advance of providing services to Medicare beneficiaries . . . .” 42 C.F.R. § 424.521(a)(1). Some Medicare contractors have created confusion because they are inclined to conflate the effective date with the retrospective billing date, as the contractor did in this case. CMS Exs. 11, 12. The distinction is important; I have the authority to review “the effective date of . . . supplier approval.” 42 C.F.R. § 498.3(b)(15). But nothing in the regulations gives me the authority to review CMS’s determinations regarding retrospective billing.

Here, on February 12, 2018, the Medicare contractor received Petitioner’s enrollment applications (CMS 855I and CMS 855R), which, after requesting and receiving additional information, the contractor subsequently approved. CMS Exs. 6-8.4 Thus, pursuant to section 424.520(d), the date Petitioner filed her subsequently-approved

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enrollment applications – February 12, 2018 – is the correct effective date of enrollment. Sokoloff, DAB No. 2972 (2019); Urology Grp., DAB No. 2860 at 7-9; Goffney, DAB No. 2763 at 7.

Pursuant to its authority under section 424.521(a)(1), CMS allowed Petitioner to bill retrospectively for a few days, back to February 8, 2018.

Petitioner, nevertheless, asks for an October 2017 enrollment date. She points out that she submitted her first applications on October 23, 2017. P. Ex. 15; P. Ex. 21 at 1 (Browning Decl. ¶ 4). As she concedes, however, the contractor rejected those applications because she did not submit, within 30 days, the additional information it requested. She blames the contractor for misinforming her, which, she claims, delayed her response. P. Ex. 21 at 2 (Browning Decl. ¶ 8). I have no authority to review the rejection of an enrollment application. 42 C.F.R. § 424.525(d); Wishon Radiological Med. Grp., Inc., DAB No. 2941 at 6-7 (2019); James Shepard, M.D., DAB No. 2793 at 8 (2017). Nor may I grant Petitioner an earlier effective date based on any equitable or policy arguments. Sokoloff, DAB No. 2972 at 9.

Conclusion

Because Petitioner filed her subsequently-approved enrollment applications on February 12, 2018, CMS properly granted her Medicare enrollment effective that date. CMS was authorized to allow her to bill retrospectively.