Lily Reitzel NP, DAB CR6983 (2026)

DECISION

Petitioner, Lily Reitzel, NP, is a nurse practitioner who participates in the Medicare program as a supplier of services.  On February 2, 2026, she applied to reassign her Medicare benefits to Comprehensive Rehab Consultants, PLLC, a group medical practice.  The Medicare contractor, acting on behalf of the Centers for Medicare & Medicaid Services (CMS) has granted her application, with a “retrospective billing date” of January 3, 2026.  Petitioner now asks for an earlier reassignment  date. 

Because she filed her subsequently-approved reassignment application on February 2, 2026, and the regulations allow CMS to grant retrospective billing of up to 30 days, February 2, 2026 is the appropriate reassignment-of-billing date, and January 3, 2026 is the earliest possible retrospective billing date. 

Background

In a notice letter, dated February 23, 2026, the Medicare contractor, National Government Services, advised Petitioner Reitzel that it approved her “Change of Information application” with a “reassignment effective date” of January 3, 2026.  CMS Ex. 3.  Petitioner requested reconsideration, asking that the date of reassignment be changed to November 10, 2025, “which aligns with the actual start of services provided

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under our group, COMPREHENSIVE REHAB CONSULTANTS PLLC.”  CMS Ex. 2 at 2. 

In a reconsidered determination, dated June 10, 2026, the Medicare contractor affirmed the initial determination, concluding that, based on the date Petitioner filed her reassignment application, her “retroactive billing date” could be no earlier than January 3, 2026.  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 neither party proposes any witnesses, an in-person hearing would serve no purpose.  See Acknowledgment and Prehearing Order at 4, 5, 6 (¶¶ 4(c)(iv), 8, 10) (June 29, 2026).  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). 

That I decide this case based on the written record does not mean that Petitioner has not had a hearing.  Courts recognize that, although a case may be decided on summary judgment or based on the written record, the administrative law judge, by considering the evidence and applying the law, has granted the petitioner a hearing.  See CNG Transmission Corp. v. FERC, 40 F.3d 289, 293 (D.C. Cir. 1994) (holding that a “paper hearing” satisfies statutory requirements for “notice and opportunity for hearing.”). 

The parties’ submissions.  CMS submits its motion and brief (CMS Br.) with five exhibits (CMS Exs. 1-5). 

Disregarding my prehearing order, Petitioner did not file a brief or any other documents in response to CMS’s submissions.  Prehearing Order at 3 (¶ 4).  Absent Petitioner’s showing good cause for failing to comply with my order, I could dismiss this appeal.  See El Medical, Inc., DAB No. 3117 at 15; Chit-Chat, Inc., DAB No. 2036 at 9 (2019) (“Compliance with ALJ orders is not optional.”).  Instead, I decide the appeal, considering the arguments made in Petitioner’s Request for Reconsideration.  See Anil Hanuman, DAB No. 3080 at 12. 

In the absence of any objections, I admit into evidence CMS Exs. 1-5.  See Acknowledgment at 5 (¶ 7). 

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Discussion

1.  Because, on February 2, 2026, Petitioner filed her subsequently-approved application to reassign her Medicare billing privileges, February 2 is the earliest possible effective date for reassignment, and January 3, 2026, is the earliest possible retrospective billing date.  42 C.F.R. §§ 424.520(d); 424.522(a); 424.521(a).1 

Enrollment.  Petitioner Reitzel is enrolled in the Medicare program as a “supplier” of services and applied to reassign her billing privileges.  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 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 non-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.  Act § 1842(b)(3)(B)(ii), (6); 42 C.F.R. § 424.80(b) and (d).  Section 424.520(d) determines the effective date of a reassignment.  Sandeep Gupta, M.D., DAB No. 3088 at 6-9 (2023), citing Timothy Ekhlassi, M.D., DAB No. 3065 at 6-7 (2022), Yakup Akyol, DAB No. 3017 at 5-6 (2020), Guarav Lakhanpal, M.D., DAB No. 2951 at 6 (2019). 

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Petitioner’s enrollment.  Here, on February 2, 2026, Petitioner filed, via the PECOS system, her application to reassign her Medicare benefits to Comprehensive Rehab Consultants PLLC (Group NPI:  1710529771; Group PTAN:  S100940741).  The Medicare contractor approved the application.  CMS Exs. 3, 4.  Thus, pursuant to section 424.520(d), the date Petitioner filed her subsequently-approved enrollment application – February 2, 2026 – is the correct effective date for the reassignment. 

A non-physician or non-physician organization may retrospectively bill for services for up to 30 days prior to the effective date, if CMS determines that certain circumstances are met.  42 C.F.R. § 424.521(a).  Thus, January 3, 2026 is Petitioner’s earliest possible retrospective billing date. 

Petitioner asks that her retrospective billing date be moved to November 10, 2025, to align with “the actual start of services provided under our group.  CMS Ex. 2 at 2. 

CMS may have the discretion to grant additional days of retrospective billing, but I do not.  I am bound by the regulations and have no authority to grant Petitioner the relief she requests.  It is well-settled that an administrative law judge may not grant relief based on equitable arguments.  Sokoloff, DAB No. 2972 at 9. 

Conclusion

I affirm the contractor’s reconsidered determination.  On February 2, 2026, Petitioner filed her subsequently-approved reassignment application.  February 2 is therefore the effective date of the reassignment of billing privileges.  42 C.F.R. § 424.520(d).  Pursuant to 42 C.F.R. § 424.521(a), January 3, 2026 is the earliest possible retrospective billing date.