Nutritionally Speaking LLC, DAB CR6972 (2026)

DECISION

Petitioner, Nutritionally Speaking LLC, is a supplier who participates in the Medicare program.  On January 5, 2026, Petitioner submitted an application to enroll in Medicare at the same time its owner, Robin Hayes submitted an application to have her billing privileges reassigned to Petitioner.  The Centers for Medicare & Medicaid Services (CMS) granted Petitioner’s application with a retrospective billing date of December 6, 2025 (and, by inference, an effective date of January 5, 2026).  Petitioner now challenges that effective date. 

Because Petitioner filed its subsequently-approved enrollment application on January 5, 2026, I find that January 5 is the correct effective date of Petitioner’s enrollment.  CMS had the authority to grant Petitioner a December 6, 2025 retrospective billing date.

Background

In a letter dated February 5, 2026, the Medicare contractor, Novitas, advised Petitioner that it approved its application with an “effective date” of December 6, 2025.  CMS Exs. 21, 22.  In fact the contractor was granting Petitioner a billing date of December 6; the effective date of Petitioner’s enrollment was January 5, 2026.

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Petitioner timely sought reconsideration, asking that the effective date of its enrollment be made retroactive to August 6, 2025, suggesting that the contractor may have requested unnecessary information and caused confusion throughout the process.  CMS Ex. 20.  In a reconsidered determination, dated May 7, 2026, the contractor denied Petitioner an earlier effective date.  CMS Ex. 21. 

Petitioner appealed. 

Although CMS has moved for summary judgment, neither party proposes any witnesses, so an in-person hearing would serve no purpose.  See Standing Order at 9-10 (May 6, 2025).  I may therefore decide the case based on the written record without considering whether the standards for summary judgment are satisfied. 

With its motion and brief (CMS Br.), CMS submits twenty-one exhibits (CMS Exs. 1-21).  Petitioner submits a written brief (P. Br.) with four attachments.  In the absence of any objections, I admit into evidence CMS Exs. 1-21. 

CMS objects to Petitioner’s attachments as new evidence without a good cause argument.  CMS also argues that the attachments labeled as docket entry 7d and 7e are not relevant to the determination of Petitioner’s effective date.  It is difficult for me to tell when the documents were created and if they were inexistence at the time of the request for reconsideration.  CMS’s other arguments go to the weight, if any, these documents are afforded.  As a result, I will admit them into evidence along with Petitioner’s other attachments. 

Discussion

Petitioner filed its subsequently-approved application on January 5, 2026, and its Medicare enrollment can be no earlier than that date.  42 C.F.R. § 424.520(d).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 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. 

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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 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 supplier 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). 

The reconsidered determination acknowledges that the contractor received Petitioner’s application on January 5, 2026, but it nevertheless mischaracterizes the “effective date” as December 6, 2025.  CMS Ex. 22.  In fact, December 6 is the retrospective billing date.  The distinction is important; I have the authority to review “the effective date of . . . supplier approval.”  42 C.F.R. § 498.3(b)(15).  But nothing in the regulations gives me the authority to review CMS’s determinations regarding retrospective billing. 

Here, on January 5, 2026, the Medicare contractor received Petitioner’s enrollment application, which the contractor subsequently approved.  CMS Exs. 21, 22.  Thus, pursuant to section 424.520(d), the date Petitioner filed its subsequently-approved enrollment application – January 5, 2026 – is the correct effective date of enrollment. 

The rejected application.  Petitioner, however, complains that the contractor improperly rejected its earlier (August 6, 2025) application.  The regulations authorize the contractor to reject an application if the supplier fails to furnish complete information within 30 days of the date requested.  42 C.F.R. § 424.525(a)(1).  According to Petitioner, the contractor requested unnecessary information which it was unable to produce and that ultimately resulted in its August 6, 2025 application being rejected.3  P. Br. at 1-4. 

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CMS disputes Petitioner’s assertion and maintains that the contractor sent Petitioner a development letter, dated August 21, 2025.  See CMS Ex. 6.  Petitioner failed to respond and the contractor sent a notice rejecting Petitioner’s August 6, 2025 application on September 23, 2025.  Petitioner argues that it was unable to provide the requested information because of the government shutdown, an incorrect mailing address provided by the IRS, and issues with PECOS.  However, I need not resolve this conflict.  Although it is possible that the Petitioner experienced the hardships described, I have no authority to review a rejected application.  42 C.F.R. § 424.525(d); see Guarav Lakhanpal, MD, DAB No. 2951 at 7 (2019); Ark. Health Grp., DAB No. 2929 at 7-9 (2019), and cases cited therein.

Conclusion

Ultimately, because Petitioner filed its subsequently-approved reenrollment application on January 5, 2026, CMS properly granted its Medicare enrollment effective that date.