Eileen Inciong, DAB, CR6888 (2026)

DECISION

I affirm the determination of the Centers for Medicare & Medicaid Services (CMS) that the effective date for the reactivation of Petitioner’s Medicare billing privileges and reassignment of Medicare benefits is December 3, 2025.

I.  Procedural History

On January 28, 2026, Petitioner requested a hearing to dispute the effective date for the reactivation of her Medicare billing privileges and the reassignment of her Medicare benefits.  On January 28, 2026, the Civil Remedies Division acknowledged the hearing request, provided a prehearing submission schedule to the parties, and issued my Standing Order.  On February 27, 2026, CMS filed a prehearing exchange, which included 12 proposed exhibits.  Petitioner did not file an exchange.

II.  Admission of Evidence

Absent objection, I admit all of CMS’s proposed exhibits into the record.  See Standing Order ¶ 10; Civil Remedies Division Procedures (CRDP) § 14(e).

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III.  Decision on the Written Record

I directed the parties to submit written direct testimony for any witnesses they wanted to offer.  Standing Order ¶ 11.  I also informed the parties as follows:

If the parties either do not file any written direct testimony or the parties do not request to cross-examine any of the witnesses from whom written direct testimony has been submitted, I will consider such actions by the parties to serve as a constructive request for a decision on the written record because there will be no reason to hold an in-person hearing.

Standing Order ¶ 7(g)(iii); see also CRDP §§ 16(b), 19(b), (d).  I further advised:  “Unless a hearing is required for cross-examination of a witness or witnesses, the record will be closed and the case will be ready for a decision after all the submission deadlines have passed.”  Standing Order ¶ 14.

Neither party submitted written direct testimony from any witnesses and all submission deadlines have passed.  Therefore, I decide this case on the written record.  Anil Hanuman, D.O., DAB No. 3080 at 11-12 (2022).

IV.  Issue

Whether December 3, 2025, is the correct effective date for the reactivation of Petitioner’s Medicare billing privileges and reassignment of Medicare benefits.

V.  Jurisdiction

I have jurisdiction to decide the issue in this case.  42 C.F.R. § 498.3(b)(15).

VI.  Findings of Fact

1. Petitioner is a physical therapist who was enrolled in the Medicare program.  See CMS Ex. 6 at 1.
2. In a July 25, 2025 notice, a CMS contractor advised Petitioner that her Medicare billing privileges were being deactivated on July 26, 2025, because Petitioner had not submitted any Medicare claims in more than six consecutive months.  CMS Ex. 2.
3. On October 18, 2025, CMS received an application (CMS-855R) for Petitioner to reassign her Medicare benefits to an entity named PT Services.  CMS Ex. 3 at 1.

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4. In an October 30, 2025 letter, the CMS contractor told Petitioner that she needed to submit a Medicare enrollment application (CMS-855I) for the contractor to process her reassignment application.  The letter stated that the contractor may reject the reassignment application if Petitioner failed to submit an enrollment application within 30 days.  CMS Ex. 4 at 1.
5. In a December 1, 2025 letter, the CMS contractor informed Petitioner that it was rejecting Petitioner’s reassignment application (CMS-855R) because Petitioner did not file an enrollment application (CMS-855I).  CMS Ex. 5 at 1.
6. On December 3, 2025, CMS received the following from Petitioner:  1) an enrollment application, i.e., an application seeking to reactivate Petitioner’s Medicare billing privileges; 2) a reassignment application, i.e., an application seeking to reassign Medicare benefits to an entity called PT Services, LLC; and 3) an application to terminate a current reassignment.  CMS Exs. 6-9.
7. In a December 12, 2025 notice, the CMS contractor approved Petitioner’s applications for the reactivation of Medicare billing privileges and the reassignment of Medicare benefits to PT Services, effective December 3, 2025.  CMS Ex. 11 at 1.
8. On December 13, 2025, Petitioner requested reconsideration of the effective date for reactivation.  CMS Ex. 11.
9. In a January 22, 2026 reconsidered determination, the CMS contractor upheld the December 3, 2025 effective date of reactivation and reassignment because the CMS contractor received Petitioner’s enrollment and reassignment applications on that date.  CMS Ex. 1 at 3-4.

VII.  Conclusions of Law and Analysis

1. The effective date of reactivation for Petitioner’s Medicare billing privileges and reassignment of Medicare benefits is December 3, 2025, because CMS received Petitioner’s reactivation enrollment application on December 3, 2025, and a CMS contractor was able to process that application to approval.

The Social Security Act (Act) authorizes the Secretary of Health and Human Services (Secretary) to promulgate regulations governing the enrollment process for providers and suppliers.  42 U.S.C. §§ 1302, 1395cc(j).  A “Supplier” for Medicare program purposes  includes “Physical therapists in private practice.  42 C.F.R. § 424.502; see also 42 U.S.C. § 1395x(d), (p); 42 C.F.R. § 410.60(a)(3)(ii), (c).  A supplier must enroll in the Medicare program to receive payment for covered items or services.  42 U.S.C. §§ 1395n(a),

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1395u(h)(1); 42 C.F.R. § 424.505.  To enroll, the supplier must submit an enrollment application and provide all required information.  42 C.F.R. § 424.510(a).

If a supplier does not submit any Medicare claims for six consecutive months, CMS may deactivate the supplier’s Medicare billing privileges.  42 C.F.R. § 424.540(a)(1).  CMS may not pay a supplier for any health care items or services provided during the period of deactivation.  42 C.F.R. §§ 424.540(e), 424.555(b); 86 Fed. Reg. 62,240, 62,359-60 (Nov. 9, 2021); see also Goffney v. Becerra, 995 F.3d 737, 743 (9th Cir. 2021).

To reactivate billing privileges, the supplier must recertify that its reenrollment information currently on file with CMS is correct and furnish any missing information.  42 C.F.R. § 424.540(b)(1).  Further, CMS may, for any reason, require a deactivated supplier file a CMS-855 enrollment application to reactive billing privileges.  42 C.F.R. § 424.540(b)(2).  When a supplier seeks reactivation, “[t]he effective date of a reactivation of billing privileges under this section is the date on which the Medicare contractor received the . . . supplier’s reactivation submission that was processed to approval by the Medicare contractor.”  42 C.F.R. § 424.540(d)(2).

Petitioner requests that October 20, 2025, be the effective date for the reactivation of billing privileges because that is the first day that Petitioner provided services to Medicare beneficiaries at PT Services.  Hr’g Req. at 1.  Petitioner argues that a CMS-855R reassignment application was timely submitted on October 18, 2025, and that the reasons stated in the reconsidered determination for denying an earlier effective date “resulted from administrative errors and processing delays beyond our control.”  Hr’g Req. at 1.  Petitioner also asserts that she previously had a valid Medicare enrollment but that her previous employer deactivated that enrollment rather than terminate Petitioner’s reassignment of Medicare benefits.  Hr’g Req. at 2.  Further, Petitioner states that the CMS contractor’s October 30, 2025 letter requesting that Petitioner file an enrollment application, and the December 1, 2025 letter rejecting the first reassignment application that was filed, were sent to the email address for a former employee, and his email was no longer monitored.  Hr’g Req. at 2.  Finally, Petitioner believes that the shutdown of the United States Government in October 2025 may have helped cause delays in processing of her applications.  Hr’g Req. at 2.

I am unable to modify the effective date for reactivation.  As stated above, the standard for setting the effective date for reactivation is the date that CMS receives the reactivation application when that application is processed to approval.  42 C.F.R. § 424.540(d)(2).  In this case, the effective date of reactivation and reassignment is December 3, 2025, because that is the date that the reactivation and reassignment applications were received, and those applications were processed to approval.

Although Petitioner believes that her Medicare billing privileges were deactivated by her previous employer, the record indicates this is incorrect.  In any event, my jurisdiction is

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limited to determining whether CMS assigned Petitioner the correct date of reactivation.  See 42 C.F.R. § 498.3(b)(15) (effective date for supplier approval is an appealable initial determination).  I do not have jurisdiction to review CMS’s decision to deactivate Petitioner’s Medicare billing privileges.  See 42 C.F.R. §§ 424.545(b), 424.546(f) (CMS has the sole authority to consider any rebuttal to the deactivation filed by a supplier); Michael B. Zafrani, M.D., DAB No. 3075 at 3, 8 (2022).

Petitioner also asserts that the October 30, 2025 notice requesting that Petitioner submit an enrollment application, and the December 1, 2025 notice rejecting Petitioner’s first application for the reassignment of benefits to PT Services, were sent to a defunct email address from a former employee with the initials R.P.  H’rg Req. at 2.  However, the reassignment application received on October 18, 2025, indicated that R.P. was a point of contact.  CMS Ex. 3 at 4.  As such, Petitioner should have been checking his email address even though R.P. later left his employment at P.T. Services.  In any event, the CMS contractor rejected the first reassignment application after providing Petitioner with 30 days to file an enrollment application, and I have no authority to review or reverse that rejection.  42 C.F.R. § 424.525(d).

Although Petitioner alleges the possibility that the government shutdown in 2025 affected the processing of her applications, the timeframes in this matter make this unlikely.  In any event, CMS may not pay Petitioner for any health care items or services provided during the period of deactivation.  42 C.F.R. §§ 424.540(e), 424.555(b).  Therefore, any potential delays in processing Petitioner’s reassignment application do not provide a legal basis to set an earlier effective date.

2. The effective date of reassignment of Petitioner’s Medicare benefits to PT Services is December 3, 2025, because that is the date for the reactivation of Petitioner’s Medicare billing privileges.

The Act permits Medicare beneficiaries to assign their Medicare benefits to a physician or non-physician supplier.  42 U.S.C. § 1395u(b)(3)(B)(ii).  In certain circumstances, a supplier who has received an assignment of benefits may reassign those benefits to an employer, individual, or entity with which the supplier has a contractual arrangement.  42 U.S.C. § 1395u(b)(6); 42 C.F.R. § 424.80(b)(1)-(2).

The reassignment of benefits is effective 30 days before the Form CMS-855R is submitted so long as all applicable requirements during that period were otherwise met.  42 C.F.R. § 424.522(a) (2025).  In the present case, Petitioner was deactivated during that 30-day period and was unable to receive payment for services provided during that period.  42 C.F.R. §§ 424.540(e), 424.555(b).  As a result, the effective date for Petitioner’s reassignment must be December 3, 2025, the date on which Petitioner’s billing privileges were reactivated.

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VIII.  Conclusion

The effective date for the reactivation of Petitioner’s Medicare billing privileges and the reassignment of Medicare benefits is December 3, 2025.