Laura Go, DAB CR6882 (2026)

DECISION

Petitioner, Laura Go, is a physician, practicing in Florida, who participates in the Medicare program as a supplier of services.  On June 18, 2025, she submitted an initial enrollment application and applied to reassign her Medicare benefits to Accountable Inpatient Services, the group medical practice that employs her.  Those applications were returned because they were filed more than 60 days prior to the effective date listed on the application.  A second application to reassign benefits was filed on September 8, 2025.  That application was closed as non-responsive.  A third application was filed on November 19, 2025.  The Centers for Medicare & Medicaid Services (CMS) approved the November 19, 2025 application, with a “reassignment effective date” of September 20, 2025.  Petitioner now asks for an earlier date.

Because she filed her subsequently-approved application on November 19, 2025, and a reassignment of benefits can be effective beginning 30 days before the application to reassign benefits (Form 855R) is submitted, with 30 days retrospective billing pursuant to 42 C.F.R. § 424.521(a)(1), September 20, 2025 is the correct effective date of reassignment.

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Background

In a notice letter, dated November 26, 2025, the Medicare contractor, First Coast Service Options (FCSO), advised Petitioner that it approved her initial enrollment and reassignment applications with a “reassignment effective date” of September 20, 2025.  CMS Ex. 8.  Petitioner requested reconsideration, asking that the date of reassignment be changed to September 11, 2025.  CMS Ex. 9.  In a reconsidered determination, dated December 30, 2025, the contractor affirmed the initial determination.  CMS Ex. 1.  Petitioner appealed, and the matter is now before me.

Decision on the written record.  CMS has moved for summary judgment.  However, because CMS proposed no witnesses and did not request to cross examine Petitioner’s proposed witness, an in-person hearing would serve no purpose.  See Standing Order at 8 - 9 (May 6, 2025).  I may therefore decide this case based on the written record, without considering whether the standards for summary judgment are satisfied.  See Anil Hanuman, D.O., DAB No. 3080 at 12 (2022).

CMS submits its motion and brief (CMS Br.) with ten exhibits (CMS Exs. 1-10).  In response, Petitioner submitted a brief and two exhibits.  In the absence of any objections, I admit into evidence CMS Exs. 1-10 and P. Exs. 1-2.  See Standing Order at 10.

Discussion

1. On November 19, 2025, Petitioner filed her subsequently-approved initial enrollment application and application to reassign benefits; her enrollment and reassignment of benefits was therefore effective 60 days earlier – on September 20, 2025.  42 C.F.R. §§ 424.522(a); 424.521(a)(1).1

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 furnished to program beneficiaries, a prospective supplier must enroll in the program.  Act § 1834(j)(1)(A); 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

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Management and Budget.  42 C.F.R. § 424.502.2  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.  For a physician, the effective date for 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).

A supplier may reassign her billing privileges under certain circumstances, including where the reassignment is to an employer or to a Medicare-enrolled entity pursuant to a contractual arrangement under which the entity bills for the supplier’s services.  42 C.F.R. § 424.80(b) and (d).

Petitioner’s enrollment.  Here, on June 18, 2025, Petitioner filed via the PECOS system, her application for initial enrollment (CMS-855I) and her application to reassign her Medicare benefits (CMS-855R).  CMS Ex. 2.  Those applications were returned because they were received more than 60 days prior to the requested September 1, 2025 reassignment effective date.  Id. at 7.

On September 8, 2025, Petitioner filed a CMS-855R reassignment of benefits application.  CMS Ex. 4.  On September 18, 2025, FCSO issued a development letter requesting the CMS-855I application.  CMS Ex. 5.  Petitioner failed to respond to the development letter, and, on October 20, 2025, the application was rejected.  CMS Ex. 6.

On November 19, 2025, Petitioner filed, via the PECOS system, her initial enrollment application and application to reassign her Medicare benefits, which the contractor subsequently approved.  CMS Ex. 7.  Thus, pursuant to sections 424.520(d) and 424.522, the date Petitioner filed her subsequently-approved enrollment applications – November 19, 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 Goffney v. Azar, No. CV 17-8032 MRW (C.D. Cal. Sept. 25, 2019).

Pursuant to section 424.522(a), the reassignment of Petitioner’s benefits is effective beginning 30 days before she submitted Form CMS-855R and pursuant to 424.521(a)(1), retrospective billing can be allowed for thirty days prior to the effective date.  As a result, the earliest the retrospective billing date can be is September 20, 2025.

Petitioner argues for the first time in her response brief that she began providing emergency services to a Medicare beneficiary on September 11, 2025, and, therefore, the Emergency Medical Treatment and Labor Act (EMTALA) requires CMS to grant her an

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effective date of September 11, 2025.  See P. Exs. 1, 2.  I agree with CMS’s assertions that these arguments should have been raised at the reconsideration level.  However, even considering Petitioner’s arguments now, Petitioner does not explain how EMTALA would authorize me to grant an earlier effective date.  See 42 U.S.C. § 1395dd.  I find that it does not.

Petitioner also argues that she was unaware that her CMS-855R filed on September 8, 2025 would be rejected because the letter she received on September 18, 2025, stated her application was under review and that a CMS-855I needed to be submitted to continue processing the application.  However, the September 18, 2025 letter starts out by explaining that her application may be rejected if she fails to respond within 30 days.  Petitioner has not disputed that she failed to provide the requested information within 30 days of September 18, 2025.

Ultimately, I have no authority to grant Petitioner the relief she requests.  Sokoloff, DAB No. 2972 at 9.  Petitioner’s EMTALA arguments were untimely raised and do not provide authority for an earlier effective date.  Additionally, I do not have authority to review CMS’s rejection of the September 8, 2025 enrollment application.  42 C.F.R. § 424.525(d).

Conclusion

On November 19, 2025, Petitioner filed her subsequently-approved initial enrollment application and application to reassign Medicare benefits.  Pursuant to 42 C.F.R. §§ 424.522(a) and 424.521(a)(1), the retrospective billing date is September 20, 2025.