Update to Chapter 15 of the Program Integrity Manual - Reconsideration Requests

Change Request (CR) 8222 was recently implemented to make revisions to Chapter 15 of the CMS 'Medicare Program Integrity Manual.' Sections and (Reconsideration Requests) are revised as follows:   The provider, supplier, or Medicare contractor may submit corrected, new, or previously omitted documentation or other facts in support of its reconsideration request of a provider enrollment denial or revocation at any time prior to the Hearing Officer's (HO’s) decision. Upon receipt of the Request for Reconsideration from the National Supplier Clearinghouse, the HO sends a letter of acknowledgement to the appealing supplier.  The HO must determine whether the denial or revocation is warranted based on all of the evidence presented. This includes:

• The initial determination itself,
• The findings on which the initial determination was based,
•  The evidence considered in making the initial determination, and
• Any other written evidence submitted under 42 CFR 498.24(a), taking into account facts relating to the status of the provider or supplier subsequent to the initial determination. 

Last Updated: 01/12/2017