Megan Miller, DAB CR7004 (2026)

DECISION

Petitioner, Megan Miller, is a physician, practicing in Ohio, who participates in the Medicare program as a supplier of services.  She reassigned her Medicare benefits to a medical practice, Mercy Health Physicians Cincinnati, LLC (Mercy Health).  The practice mistakenly terminated her Medicare reassignment.  When she realized what had occurred, she reapplied, again reassigning her benefits to Mercy Health.  The Centers for Medicare & Medicaid Services (CMS) has granted her application, with an effective date of April 22, 2026. 

Petitioner now asks for an earlier effective date. 

Because she filed her subsequently-approved Medicare reapplication on May 22, 2026, I find that May 22 is the correct effective date for Petitioner’s enrollment.  The regulations allow CMS to grant retrospective billing of up to 30 days, making April 22, 2026 the appropriate retrospective billing date.1 

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Background

In a notice letter, dated June 5, 2026, the Medicare contractor, Celerian Government Services, advised Petitioner Miller that it approved her Medicare enrollment and reassignment application, with the “reassignment effective date” of April 22, 2026.  CMS Ex. 2. 

Petitioner requested reconsideration, asking for an effective date of January 2, 2026, the date her employer erroneously terminated her reassignment of billing privileges.   Petitioner explained that her employer had confused her with another supplier who had the same name.  CMS Ex. 3. 

In a reconsidered determination, dated July 17, 2026, the contractor affirmed the initial determination.  CMS Ex. 4.  Petitioner appealed. 

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 Pre-Hearing Order at 4, 5, 6 (¶¶ 4(c)(iv), 8, 10) (August 5, 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 six exhibits (CMS Exs. 1-6).  In the absence of any objections, I admit into evidence CMS Exs. 1-6.  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, 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. 

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Discussion

1. Because Petitioner filed her subsequently-approved reassignment application on May 22, 2026, May 22 is the earliest possible effective date for the reassignment, and CMS was authorized to make April 22, 2026 the retrospective billing date.  42 C.F.R. §§ 424.520(d), 424.522(a), 424.521(a).3

Enrollment.  Petitioner Miller participates in the Medicare program as a “supplier” of services and applied to reassign her billing privileges to Mercy Health.  CMS Ex. 1; see 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 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. 

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If a physician 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).  I have no authority to review CMS’s determinations regarding retrospective billing.  See 42 C.F.R. § 498.3(b). 

Petitioner’s enrollment.  From September 29, 2023, until January 1, 2026, Petitioner Miller was enrolled in the Medicare program and reassigned her Medicare benefits to Mercy Health.  The medical practice submitted an application to the Medicare contractor, asking to voluntarily terminate the reassignment, effective January 1, 2026.  CMS Ex. 5 at 4;  CMS Ex. 6 at 68.  See 42 C.F.R. § 424.502 (defining “voluntary termination).  The contractor subsequently approved the request. 

On May 22, 2026, Petitioner filed a new Medicare enrollment application, again asking to reassign her benefits to Mercy Health.  CMS Ex. 1.  The contractor approved.  CMS Ex. 2.  Pursuant to sections 424.520(d) and 424.522(a)(1), the date Petitioner filed her subsequently-approved reassignment application – May 22, 2026 – is the correct effective date. 

Pursuant to its authority under section 424.521(a)(1), CMS has allowed Petitioner to bill 30-days retrospectively, so her retrospective billing date is April 22, 2026. 

That the medical practice terminated Petitioner’s enrollment in error (apparently, the practice’s credentialling employee confused Petitioner with another employee who had the same name) cannot change the result here.  The regulations are explicit.  I have no authority to grant Petitioner an earlier effective date based on any equitable or policy arguments.  Howard M. Sokoloff, DPM, MS, Inc., DAB No. 2972 at 9 (2019).

Conclusion

Because Petitioner filed her subsequently-approved Medicare application on May 22, 2026, May 22 is the correct effective date for the reassignment of her benefits.