Cynthia Evans, FNP-C, DAB CR7003 (2026)

DECISION

Petitioner, Cynthia Evans, FNP-C, is a nurse practitioner who participates in the Medicare program as a supplier of services.  On February 11, 2026, she filed her second application to reassign her Medicare benefits to NP Health of MI, 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 billing date of January 12, 2026.  Petitioner now asks for an earlier reassignment date.

Because she filed her subsequently-approved reassignment application on February 11, 2026, and the regulations allow CMS to grant retrospective billing of up to 30 days, February 11, 2026 is the appropriate reassignment-of-billing date, and January 12, 2026 is the earliest possible retrospective billing date.

Background

In a notice letter, dated March 12, 2026, the Medicare contractor, Wisconsin Physicians Service Insurance Corporation, advised Petitioner Evans that it approved her “Change of Information application” with a “reassignment effective date” of January 12, 2026.  CMS

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Ex. 8.1  Petitioner requested reconsideration, asking that the date of reassignment be changed to November 3, 2025, “which aligns with the actual start of services provided under our group, NP Health of MI PLLC.”  CMS Ex. 9.

In a reconsidered determination, dated June 23, 2026, the Medicare contractor affirmed the initial determination, concluding that, based on the date Petitioner filed her reassignment application, her “effective date of participation” would remain the same.  CMS Ex. 10 at 3.

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) (July 8, 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); Emery Cnty. Care & Rehab. Ctr., DAB No. 3006 at 5-8 (2020); James Brian Joyner, M.D., DAB No. 2902 at 12 (2018); see CRDP ¶ 16(b).2 

The parties’ submissions.  CMS submits its motion and brief (CMS Br.) with ten exhibits (CMS Exs. 1-10).  In the absence of any objections, I admit into evidence CMS Exs. 1-10.  See Prehearing Order at 5 (¶ 7).

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 EI Med., Inc., DAB No. 3117 at 15 (2023); Chit-Chat, Inc., DAB No. 2036 at 9 (2019) (“Compliance with ALJ orders is not optional.”).  Instead, I decide the appeal,

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considering the arguments made in Petitioner’s Request for Reconsideration and Request for an Administrative Law Judge Hearing.  See Anil Hanuman, DAB No. 3080 at 12.

Discussion

1. Because, on February 11, 2026, Petitioner filed her subsequently-approved application to reassign her Medicare billing privileges, February 11 is the earliest possible effective date for reassignment, and January 12, 2026, is the earliest possible retrospective billing date.  42 C.F.R. §§ 424.520(d), 424.522(a), 424.521(a).3

Enrollment.  Petitioner Evans is enrolled in the Medicare program as a “supplier” of services and applied to reassign her billing privileges.  Social Security Act (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. § 424.502.4  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), (d).  Sections 424.520(d) and 424.522(a)(1) determine the effective date of a reassignment.

Petitioner’s enrollment:  the first application.  On November 4, 2025, Petitioner submitted to the Medicare contractor an application to reassign benefits to NP Health of MI, PLLC.  CMS Ex. 1.  However, in a letter dated November 10, 2025, the Medicare contractor directed her to submit additional information.  The letter warned that the contractor might reject her application if she did not furnish the complete information within 30 calendar days from the postmarked/emailed date of the letter.  CMS Ex. 2.  When Petitioner did not respond, the contractor rejected her application pursuant to 42 C.F.R. § 424.525.  CMS Ex. 3.  Enrollment applications that are rejected are not afforded appeal rights.  42 C.F.R. § 424.525(d).

Petitioner’s enrollment:  the subsequently-approved application.  On February 11, 2026, Petitioner filed a second application to reassign her Medicare benefits to NP Health of MI, PLLC.  CMS Ex. 4.  After some additional development (CMS Exs. 6, 7), the contractor approved the February 11 application.  CMS Ex. 8.  Thus, pursuant to sections 424.520(d) and 424.522(a)(1), the date Petitioner filed her subsequently-approved reassignment application – February 11, 2026 – is the correct effective date for the reassignment.

A non-physician or non-physician organization may retrospectively bill for services provided up to 30 days prior to the effective date, if CMS determines that certain circumstances are met.  42 C.F.R. § 424.521(a); 42 C.F.R. § 424.522(a)(2).  Thus, January 12, 2026, is Petitioner’s earliest possible retrospective billing date.

Petitioner asks that her retrospective billing date be moved to November 3, 2025, to align with “the actual start of services provided under our group.”  However, 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.  Howard M. Sokoloff, DPM, MS, Inc., DAB No. 2972 at 9 (2019).

Conclusion

I affirm the contractor’s reconsidered determination.  On February 11, 2026, Petitioner filed her subsequently-approved reassignment application.  February 11 is therefore the effective date of the reassignment of the Medicare billing privileges.  42 C.F.R. § 424.520(d), 424.522(a)(1).  Pursuant to 42 C.F.R. §§ 424.521(a) and 424.522(a)(2), January 12, 2026 is the earliest possible retrospective billing date.