Clark Fork Valley Ambulance Service Inc., DAB CR6704 (2025)

DECISION

This decision affirms the determination of Noridian Healthcare Solutions (Noridian), a Medicare administrative contractor for the Centers for Medicare & Medicaid Services (CMS), that the effective date of Clark Fork Valley Ambulance Service Inc.’s (Petitioner) Medicare enrollment and billing privileges is March 23, 2024. 

I. Background and Procedural History

Petitioner is an ambulance service located in Clark Fork, Idaho, and enrolled as a supplier in the Medicare program.  CMS Exs. 1, 10.  

Petitioner’s Medicare billing privileges were deactivated effective December 7, 2023, due to Failure to Report a Change of Information.  CMS Ex. 2. 

After submitting two reenrollment applications, Petitioner’s Medicare billing privileges were reactivated on March 23, 2024.  CMS Exs. 1, 6, 9. 

On November 7, 2024, Petitioner, timely requested a hearing before an administrative law judge (ALJ) to contest the effective date of its Medicare enrollment.  

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The Civil Remedies Division (CRD) issued an acknowledgment order and my standing prehearing order (Standing Order), along with the CRD Procedures (CRDP) on November 12, 2024.  

On December 17, 2024, CMS filed a brief and a Motion for Summary Judgment (CMS Br.), along with 10 exhibits (CMS Exs. 1-10). 

On January 1, 2025, Petitioner filed a timeline of events, along with three additional documents (DAB E-File Dkt. C-25-106, Doc. Nos. 8, 8a, 8b, 9).1

II. Jurisdiction

I have jurisdiction to hear and decide this case.  42 C.F.R §§ 498.3(b)(15), 498.5(l)(2); see also 42 U.S.C. § 1395cc(j)(8).  

III. Issue

Whether Noridian, acting on behalf of CMS, properly assigned March 23, 2024 as the effective date for Petitioner’s reactivated Medicare billing privileges. 

IV. Admission of Exhibits and Decision on the Written Record

In the absence of objections, all exhibits are admitted into the record.  

Neither party identified witnesses for cross-examination.  Therefore, CMS’ motion for summary judgment is moot, and this matter will be decided on the written record.  CRDP at 18, 19; Standing Order at 8.  

V. Findings of Fact

1. Petitioner is a volunteer-ambulance service enrolled as a supplier in the Medicare Part B program.  CMS Ex. 1.  
2. By letter dated December 13, 2023, Noridian informed Petitioner that its Medicare billing privileges were being deactivated effective December 7, 2023, due to Failure to Report a Change of Information as required by 42 C.F.R. § 424.540(a)(2).  According to Noridian, Petitioner failed to report the July 30, 2023 death of the person listed as a director/officer on Petitioner’s Medicare enrollment application.  CMS Ex. 2. 

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3. On January 15, 2024, Petitioner filed a CMS-855B reactivation application to reactivate its billing privileges.  CMS Ex. 1.
4. By email dated February 6, 2024, Noridian informed Petitioner that the CMS-855B application was incomplete and requested that Petitioner submit additional information by March 7, 2024.  CMS Ex. 4.  Specifically, the email requested an electronic funds transfer agreement, a current copy of registration for each ambulance service supplier vehicle, and a copy of IRS generated documentation confirming the legal business name and tax identification number.  CMS Ex. 5 at 2.
5. Noridian received additional information from Petitioner on March 1, 2024.  However, the legal business name on the bank letter did not match the IRS generated documentation.  DAB E-File Dkt. C-25-106, Doc. No. 1a.  A Noridian representative sent Petitioner an email on March 1, 2024, requesting additional information on the electronic funds transfer portion of Petitioner’s CMS-855B application.  CMS Ex. 5.
6. By letter dated March 7, 2024, Noridian rejected Petitioner’s January 15, 2024 CMS-855B application due to incomplete information.  CMS Ex. 6.  
7. Petitioner filed a second CMS-855B reactivation application on March 23, 2024. CMS Ex. 1 at 1.  
8. By letter dated May 20, 2024, Noridian informed Petitioner that its reactivation enrollment application was approved with a reactivation date of March 23, 2024.  CMS Ex. 9.
9. On July 11, 2024, Petitioner filed a request for reconsideration seeking an effective date of December 7, 2023.
10. On September 30, 2024, Noridian issued an unfavorable reconsideration determination.  DAB E-File Dkt. C-25-106, Doc. No. 1a. 

IV. Analysis and Conclusions of Law

The Social Security Act (the Act) establishes the enrollment process for providers and suppliers participating in Medicare or Medicare related programs.  42 U.S.C. §§ 1302, 1395cc(j).  Under the Act, “suppliers” are physicians or other practitioners, a facility, or other entity (other than a provider of services) that furnishes items or services under the Medicare provisions of the Act.  42 U.S.C. § 1395x(d); see also 42 U.S.C. § 1395x(u). Providers include hospitals, skilled nursing facilities, and home health agencies.  

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42 U.S.C. § 1395x(u).  Petitioner is an ambulance service enrolled in the Medicare program as a “supplier.”  42 U.S.C. § 1395x(d); 42 C.F.R. §§ 400.202, 410.40(b)(1), 498.2; CMS Ex. 1.  

A provider or supplier must be enrolled in the Medicare program in order to receive payment for covered items or services from either Medicare (in the case of an assigned claim) or a Medicare beneficiary.  42 C.F.R. § 424.505.  Once enrolled, the provider or supplier receives billing privileges and is issued a valid billing number effective for the date a claim was submitted for an item that was furnished or a service that was rendered.  42 C.F.R. § 424.505. 

CMS can deactivate an enrolled supplier’s Medicare billing privileges if the supplier fails to report a change to the information supplied on the enrollment application within the applicable time period.  42 C.F.R. § 424.540(a)(2).  It is undisputed that Petitioner failed to report the death of the person listed as a director/officer on its Medicare enrollment application, which resulted in the deactivation of its Medicare billing privileges. 

Despite the deactivation, Petitioner requests that its claims from December 7, 2023 through March 23, 2024 be paid.  Petitioner states that the “ordeal with Noridian” has been a huge hardship on its volunteer service and that its enrollment was deactivated without notice.  CMS Ex. 10.  However, once CMS deactivates a supplier’s Medicare billing privileges, “[n]o payment may be made for otherwise Medicare covered items or services furnished to a Medicare beneficiary.”  42 C.F.R. § 424.555(b); 42 C.F.R. § 424.540(e).  The Departmental Appeals Board (DAB) has also stated that “[i]t is certainly true that [the petitioner] may not receive payment for claims for services during any period when his billing privileges were deactivated.”  Willie Goffney, Jr., M.D., DAB No. 2763 at 6 (2017).  Moreover, I have no authority to review a deactivation.  Michael B. Zafrani, M.D., DAB No. 3075 at 3, 8 (2022). 

To reactivate its billing privileges, a supplier must recertify that its enrollment information currently on file with Medicare is correct, furnish any missing information, as appropriate, and comply with all applicable enrollment requirements.  42 C.F.R. § 424.540(b)(1).  CMS may also require that a deactivated supplier submit a complete enrollment application.  42 C.F.R. § 424.540(b)(2).  

The effective date of reactivation of billing privileges is the date that Noridian received the supplier’s application that was processed to approval.  42 C.F.R. § 424.540(d)(2). Though Petitioner initially filed a reactivation application on January 15, 2024, that application was rejected due to incomplete information.  I have no authority to review a rejected application.  42 C.F.R. § 424.525(d).  On March 23, 2024, Petitioner filed a second reactivation application which Noridian processed and approved.  CMS Ex. 9.  Therefore, Noridian did not err in providing Petitioner with an effective date of March 

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23, 2024, the date of receipt of the application that was processed to approval.  42 C.F.R. § 424.540(d)(2). 

Petitioner voices several frustrations about Noridian’s process, and the service provided by its employees.  DAB E-File Dkt. C-25-106, Doc. No. 8a.  Specifically, Petitioner claims that the Noridian representative did not explain the process in detail via telephone or email, and the representative only made threats to deactivate, as opposed to providing additional assistance.  Id.  However, Petitioner’s frustrations about the process does not negate its responsibility to comply with the requirements of the Medicare program.  Petitioner also argues that losing three months of revenue is crippling to their volunteer ambulance organization.  CMS Ex. 10.  Petitioner’s argument is construed as a request for equitable relief.  However, the regulations do not provide me with the authority to grant equitable relief; thus, Petitioner’s effective date cannot be changed based upon the reasons provided.  US Ultrasound, DAB No. 2302 at 8 (2010) (“Neither the ALJ nor the Board is authorized to provide equitable relief by reimbursing or enrolling a supplier who does not meet statutory or regulatory requirements.”).  For the reasons explained above, I conclude that Petitioner’s reactivation date of March 23, 2024 is correct. 

IV. Conclusion

CMS correctly determined that Petitioner’s effective date for the reactivation of Medicare billing privileges is March 23, 2024.  Therefore, CMS’s determination is AFFIRMED.