Susan K. Harrington, DMIN, DAB CR6819 (2026)

DECISION

Petitioner, Susan K. Harrington, DMIN, is a psychotherapist, practicing in Massachusetts, who applied to participate in the Medicare program as a supplier of services.  The Centers for Medicare & Medicaid Services (CMS) granted her application, effective February 26, 2025, with a retrospective billing date of January 27, 2025.  Petitioner asks that her billing date be changed to January 1, 2024, the date she began furnishing services to Medicare beneficiaries.

Because Petitioner filed her subsequently-approved enrollment application on February 26, 2025, February 26, 2025 is the correct effective date of Petitioner’s enrollment.  CMS had the authority to grant Petitioner a 30-day retrospective billing date.

Background

In a letter dated March 17, 2025, the Medicare contractor, National Government Services, advised Petitioner Harrington that it approved her Medicare enrollment application with an effective date of February 26, 2025.  CMS Ex. 3.

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Petitioner sought reconsideration, asking that the effective date of her enrollment be made retroactive to January 1, 2024.  She explained that Blue Cross/Blue Shield had stopped paying claims for her services after that date and that she had been eligible to enroll in the program at that time.  She sought recoupment for the services she rendered in 2024.  CMS Ex. 2 at 1.

In a reconsidered determination, dated August 7, 2025, the contractor’s enrollment specialist denied Petitioner an earlier effective date.  However, citing 42 C.F.R. § 424.521(a), the enrollment specialist allowed Petitioner a retrospective billing date of January 27, 2025.  That provision allows a non-physician practitioner (and other categories of suppliers) to bill retrospectively for services if the supplier has met all program requirements and meets certain other conditions.  Unless a presidentially-declared disaster precluded the supplier’s earlier enrollment, the period of retrospective billing is limited to 30 days.  CMS Ex. 1.

Petitioner appealed.

CMS has moved for summary judgment.  Petitioner did not respond to CMS’s motion nor did she submit a prehearing exchange, as ordered.  Acknowledgment and Pre-hearing Order at 3 (¶ 4b).1  Nevertheless, she has not indicated that she has abandoned her appeal.  I therefore decide this case based on the record before me, which includes the arguments Petitioner made at the reconsideration stage and in her appeal from the reconsidered determination.  See Anil Hanuman, D.O., DAB No. 3080 at 12 (2022).

Hearing on the written record.  Although CMS has moved for summary judgment, neither party proposes any witnesses, so an in-person hearing would serve no purpose.  See Acknowledgment and Pre-hearing Order at 4, 5-6 (¶¶ 4(c)(iv), 8-10) (October 7, 2025).  I may therefore decide the case based on the written record without considering whether the standards for summary judgment are satisfied.  See Hanuman, DAB No. 3080 at 11-12; Emery County Care and Rehab. Ctr., DAB No. 3006 at 5-8 (2020); James Brian Joyner, DAB No. 2902 at 12 (2018); see CRD Procedures ¶ 16(b).

With its motion and brief (CMS Br.), CMS submits six exhibits (CMS Exs. 1-6).  In the absence of any objections, I admit into evidence CMS Exs. 1-6.  See Acknowledgment at 5 (¶ 7).

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Discussion

Petitioner filed her subsequently-approved application on February 26, 2025, and her Medicare enrollment can be no earlier than that date.  42 C.F.R. § 424.520(d).2 

Enrollment.  Petitioner participates in the Medicare program as a “supplier” of services.  Social Security Act § 1861(d); 42 C.F.R. § 498.2.  To receive Medicare payments for the services it furnishes 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 the individual began furnishing services at a new practice location.  42 C.F.R. § 424.520(d) (Emphasis added).  The date of filing is the date the Medicare contractor receives an application.  Karthik Ramaswamy, M.D., DAB No. 2563 at 3 (2014), aff’d sub nom. Ramaswamy v. Burwell, 83 F. Supp. 3d 846 (E.D. Mo. 2015).

If a non-physician practitioner meets all program requirements, CMS may allow her 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).

Petitioner’s enrollment.  Here, on February 26, 2025, the Medicare contractor received Petitioner’s enrollment application (CMS-855I), which the contractor subsequently

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approved.  CMS Exs. 3, 5.  Thus, pursuant to section 424.520(d), the date Petitioner filed her subsequently-approved enrollment application – February 26, 2025 – is the correct effective date of 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).

I have no authority to grant Petitioner an earlier effective date based on equitable or policy arguments.  Sokoloff, DAB No. 2972 at 9.

Conclusion

Because Petitioner filed her subsequently-approved enrollment application on February 26, 2025, CMS properly granted her Medicare enrollment effective that date.