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HHS/CMS RIN: 0938-AI49 Publication ID: Fall 2008 
Title: Appeals of CMS or Contractor Determination When a Provider or Supplier Fails To Meet the Requirements for Medicare Billing (CMS-6003-F) 
Abstract: This final rule extends appeal rights to all suppliers whose enrollment applications for Medicare billing privileges are disallowed by a carrier or whose Medicare billing privileges are revoked, except for those suppliers covered under other existing appeals provisions of our regulations. In addition, certain appeal provisions are revised to correspond with the existing appeal provisions in those other sections of our regulations. It also extends appeal rights to all suppliers not covered by existing regulations to ensure they have a full and fair opportunity to be heard. This rule incorporates provisions from section 936 of the Medicare Modernization Act. 
Agency: Department of Health and Human Services(HHS)  Priority: Other Significant 
RIN Status: Previously published in the Unified Agenda Agenda Stage of Rulemaking: Completed Actions 
Major: No  Unfunded Mandates: No 
CFR Citation: 42 CFR 405.874    42 CFR 424.525    42 CFR 424.535    42 CFR 424.545    42 CFR 498.1 and 498.2    42 CFR 498.5    42 CFR 498.22    42 CFR 498.40    42 CFR 498.44    42 CFR 498.56    42 CFR 498.78 and 498.79    42 CFR 498.86    42 CFR 498.88    42 CFR 405.802    42 CFR 424.510    ...     (To search for a specific CFR, visit the Code of Federal Regulations.)
Legal Authority: 42 USC 1302    42 USC 1395u(b)(3)(C)    42 USC 1395ff(b) and 1395hh   
Legal Deadline:  None
Timetable:
Action Date FR Cite
NPRM  10/25/1999  64 FR 57431   
Second NPRM  03/02/2007  72 FR 9479   
Second NPRM Comment Period End  05/02/2007    
Final Action  06/27/2008  73 FR 36448   
Regulatory Flexibility Analysis Required: No  Government Levels Affected: None 
Small Entities Affected: Businesses  Federalism: No 
Included in the Regulatory Plan: No 
RIN Data Printed in the FR: No 
Agency Contact:
August Nemec
Health Insurance Specialist
Department of Health and Human Services
Centers for Medicare & Medicaid Services
Office of Financial Management, Program Integrity Group, Mailstop C3-02-16, 7500 Security Boulevard,
Baltimore, MD 21244
Phone:410 786-0612
Email: august.nemec@cms.hhs.gov