Asian Healthlink, DAB CR6971 (2026)

DECISION

Petitioner, Asian Healthlink, is a group practice clinic.  After the Medicare contractor deactivated its Medicare billing privileges, Petitioner submitted a new application, seeking to reactivate its enrollment.  Acting on behalf of the Centers for Medicare & Medicaid Services (CMS), the contractor approved the application, with an effective billing date of December 3, 2025.  As a result, Petitioner’s billing privileges lapsed from October 1, 2025 through December 2, 2025.

Petitioner challenges the deactivation, claiming that circumstances beyond its control resulted in its Medicare enrollment being deactivated.  Petitioner also argues that it did not receive notice of the deactivation.  Petitioner asks that the lapse in billing privileges be rescinded.

Because Petitioner filed its subsequently-approved reactivation application on December 3, 2025, December 3 is the earliest possible effective date for its Medicare reactivation.  See 42 C.F.R. § 424.540(d)(2).

I have no authority to review the deactivation nor to order retrospective reimbursement for services provided during the period of deactivation.

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Background

The Medicare contractor, Noridian, approved Petitioner’s reactivation enrollment application, effective December 3, 2025.  CMS Ex. 4.  Petitioner requested reconsideration.  CMS Ex. 5.  In a reconsidered determination, dated March 20, 2026, a contractor representative affirmed the December 3, 2025 effective date.  CMS Ex. 5.

Petitioner appealed, and the matter is now before me.

CMS moves for summary judgment.  However, because neither party requested to cross-examine any of the proposed witnesses, an in-person hearing would serve no purpose.  See Acknowledgment and Pre-Hearing Order at 9-10 (May 6, 2025).  I may therefore decide this case based on the written record, without considering whether the standards for summary judgment are satisfied.

CMS submits its motion and brief (CMS Br.) with five exhibits (CMS Exs. 1-5).  Petitioner submits its argument in response (P. Br.) with nine exhibits (P. Exs. A-I).  In the absence of any objections, I admit into evidence CMS Exs. 1-5 and P. Exs. A-I.  See Pre-Hearing Order at 8.

Discussion

1. On December 3, 2025, Petitioner filed its subsequently-approved Medicare reactivation application, and the effective date of its reactivation can be no earlier than that date.  42 C.F.R. § 424.540(d)(2).1

Enrollment.  Petitioner participates in the Medicare program as a “supplier” of services.  CMS Ex. 6 at 1; CMS Ex. 8 at 1; see Social Security Act § 1861(d); 42 C.F.R. §§ 400.202, 498.2.  To receive Medicare payments for the services furnished to program beneficiaries, a supplier must enroll in the program.  Act §§ 1834(j), 1835(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 Management and Budget.  42 C.F.R. § 424.502.2  When CMS determines that a

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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 physician and non-physician practitioner organizations submitting a new enrollment application, 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).  However, because this case involves re-enrollment after a deactivation, additional regulations apply.

Deactivation and reactivation.  To maintain its billing privileges, a supplier must resubmit and recertify the accuracy of its enrollment information every five years.  42 C.F.R. § 424.515.  CMS may perform off-cycle revalidations at any time.  42 C.F.R. § 424.515(d).  Within 60 days of receiving CMS’s notice, the supplier must submit the applicable enrollment application and supporting documentation.  42 C.F.R. § 424.515(a)(2).  CMS may deactivate a supplier’s billing privileges if the supplier does not furnish complete and accurate information and all supporting documentation within 90 calendar days of receiving CMS’s request that it do so.  42 C.F.R. § 424.540(a)(3).

To reactivate its billing privileges, the 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 on which the Medicare contractor received the supplier’s submissions that were processed to approval.  42 C.F.R. § 424.540(d)(2).

Here, in a letter dated June 25, 2025, the contractor directed Petitioner to revalidate its Medicare enrollment no later than September 30, 2025.  The letter cautioned that the contractor might stop Petitioner’s billing privileges if it didn’t receive a timely response.  Petitioner would not be paid for services rendered during the period of deactivation.  CMS Ex. 1.

Petitioner did not respond.

In a notice letter dated November 6, 2025, the contractor advised Petitioner that, because it had not timely revalidated its enrollment, the practice’s Medicare billing privileges were deactivated, effective October 1, 2025, pursuant to 42 C.F.R. § 424.540(a)(3).  CMS Ex. 2.  Section 424.540(a)(3) authorizes the contractor to deactivate a supplier’s Medicare billing privileges if the supplier does not comply with all enrollment requirements.

On December 3, 2025, Medicare contractor received Petitioner’s Medicare application (Form CMS-855B), which it processed to approval.  CMS Ex. 3.  December 3, 2025 is

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therefore the effective date for reactivating Petitioner’s billing privileges.  See 42 C.F.R. § 424.540(d)(2).

Petitioner explains in its brief that it diligently tried to respond to the request for revalidation, but that a fire at its CFO’s office prevented it from obtaining the required documentation.  See P. Br; P. Ex. B.  Petitioner further explains that it did not understand that a failure to respond would result in deactivation of all Medicare billing privileges.  Id.  While a fire is an incredibly unfortunate event, it does not negate the fact that Petitioner failed to respond to the reactivation request resulting in its deactivation.  And, ultimately, I have no authority to review a deactivation.

Similarly, I may not I grant Petitioner an earlier effective date based on any equitable or policy arguments.  Howard M. Sokoloff, DPM, MS, Inc., DAB No. 2972 at 6, 9 (2019); Wishon Radiological Med. Grp., Inc., DAB No. 2941 at 6-7 (2019); Ark. Health Grp., DAB No. 2929 at 7-9 (2019); James Shepard, M.D., DAB No. 2793 at 8 (2017).  Petitioner asserts that the loss of billing privileges from October 1, 2025 through December 2, 2025 has caused financial hardship.  As a result, Petitioner requests an earlier effective date.  However, as noted above, I do not have the authority to grant Petitioner the relief it is requesting.

Nor may I direct the contractor to allow retrospective reimbursement.  A supplier may not receive payment for services or items furnished while deactivated.  42 C.F.R. §§ 424.540(e), 424.555(b).  This represents a departure; CMS previously permitted retrospective billing after reactivation.  In promulgating the new regulation, the Secretary explained the change:

After careful reflection . . . the most sensible approach from a program integrity perspective is to prohibit such payments altogether.  In our view, a provider or supplier should not be effectively rewarded for its non-adherence to enrollment requirements (for example, failing to respond to a revalidation request or failing to timely report enrollment information changes) by receiving payment for services or items furnished while out of compliance.

86 Fed. Reg. 62,240, 62420-21 (Nov. 9, 2021); see Michael B. Zafrani, M.D., DAB No. 3075 at 2 n.1 (2022).

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Conclusion

Because Petitioner filed its subsequently-approved reactivation application on December 3, 2025, December 3 is the earliest possible effective date.  See 42 C.F.R. § 424.540(d)(2).

I may not review the deactivation.

Retrospective reimbursement is not available for those whose enrollment has been deactivated.  42 C.F.R. § 424.540(e).