Skip to main content


U.S. flag
      An official website of the United States government
              Here’s how you know
        Here’s how you knowDot gov**Official websites use .gov**
                 A **.gov** website belongs to an official government organization in the United States.
                  HTTPS**Secure .gov websites use HTTPS**
                 A **lock** (A locked padlock) or **https://** means you’ve safely connected to the .gov website. Share sensitive information only on official, secure websites. 
  Menu Close
          HHS Search block
    Search
        








  
  
    

  
      

                                      About HHS
    
                        
                              
      
      
      Programs & Services
    
                        
                              
      
      
      Grants & Contracts
    
                        
                              
      
      
      Laws & Regulations Breadcrumb
    Home
                              About
                              Agencies
                              DAB
                              Decisions
                              ALJ Decisions
                              2020
                              Hudson Chiropractic Corporation, ALJ Ruling 2021-1 (HHS CRD Nov. 17, 2020)
 Navigate to:
  Departmental Appeals Board (DAB)
    
                                                  
                                                    
            
      
      
      
      About DAB
                                            
            
            Organizational Overview
    
                                                  
                              
            
      
      
      
      Who are the Judges?
    
                                                  
                              
            
      
      
      
      DAB Divisions
    
                                                  
                              
            
      
      
      
      Contact DAB
    
                                                  
                                                    
            
      
      
      
      Filing an Appeal Online
                                            
            
            DAB E-File
    
                                                  
                              
            
      
      
      
      Medicare Operations Division (MOD) E-File
    
                                                  
                                                    
            
      
      
      
      Different Appeals at DAB
                                            
            
            Appeals to DAB Administrative Law Judges (ALJs)
                          
            
            Forms
    
                                                  
                              
            
      
      
      
      Procedures
    
                                                                
                                                    
            
      
      
      
      Appeals to Board
                          
            
            Practice Manual
    
                                                  
                              
            
      
      
      
      Guidelines
    
                                                  
                              
            
      
      
      
      Regulations
    
                                                  
                              
            
      
      
      
      National Coverage Determination Complaints
    
                                                                
                                                    
            
      
      
      
      Appeals to the Medicare Appeals Council (Council)
                          
            
            Forms
    
                                                  
                              
            
      
      
      
      Fully Integrated Duals Advantage (FIDA) Demonstration Project
    
                                                  
                                                    
            
      
      
      
      Alternative Dispute Resolution Services
                                            
            
            Sharing Neutrals
    
                                                  
                              
            
      
      
      
      ADR Training
    
                                                  
                              
            
      
      
      
      Other ADR Services
    
                                                  
                                                    
            
      
      
      
      DAB Decisions
                                            
            
            Board Decisions
    
                                                  
                              
            
      
      
      
      DAB Administrative Law Judge (ALJ) Decisions
    
                                                  
                              
            
      
      
      
      Medicare Appeals Council (Council) Decisions
    
                                    
                              
            
      
      
      
      Stakeholder Feedback
    
                                                  
                                                    
            
      
      
      
      Careers
                                            
            
            Open Career Opportunities
    
                                                  
                              
            
      
      
      
      Internships & ExternshipsText resize icon

                    




Hudson Chiropractic Corporation, ALJ Ruling 2021-1 (HHS CRD Nov. 17, 2020)








  
  
    

  
      
Department of Health and Human Services 
    DEPARTMENTAL APPEALS BOARD
          Civil Remedies Division





Hudson Chiropractic Corporation,
(PTAN: Z78449)
(NPI: 1639218928)
Petitioner,

v.

Centers for Medicare & Medicaid Services.
Docket No. C-19-103Ruling No. 2021-1November 17, 2020

        
              
    

      REMAND

Petitioner, Hudson Chiropractic Corporation, participates in the Medicare program as a supplier of services.  After its Medicare billing privileges were deactivated, it applied to re-enroll in the program.  The Centers for Medicare & Medicaid Services (CMS) granted the application, with an effective date of April 19, 2018.  Petitioner appeals.

Because no evidence in this record establishes the date Petitioner filed its subsequently-approved re-enrollment application, and because CMS has ignored my orders to supply such evidence, I remand this matter to CMS to give the agency an opportunity to develop evidence necessary to establish the correct effective date for Petitioner's re-enrollment.

Discussion

Petitioner participates in the Medicare program as a "supplier" of services.  Social Security Act § 1861(d); 42 C.F.R. § 498.2.  To receive Medicare payments for the services it furnishes to program beneficiaries, a prospective supplier must enroll in the program.  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

**Page 2**

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. § 424.502.1
  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 practitioner organization, the effective date for its billing privileges "is the *later*of the date of filing" a subsequently-approved enrollment application or "the date that [it] first began furnishing services at a new practice location."  42 C.F.R. § 424.520(d) (emphasis added).

In this case, by letter dated May 4, 2018, the Medicare contractor, Noridian Healthcare Solutions, advised Petitioner that it approved its Medicare re-enrollment application, although with a gap in its billing privileges from April 4 through 18, 2018, which means that Petitioner's effective date of re-enrollment is April 19, 2018 (although the letter did not mention that date).  CMS Ex. 3.

Petitioner requested reconsideration.  The contractor issued a reconsidered determination, dated October 3, 2018.  There, after finding that Petitioner filed its application to revalidate and reactivate its Medicare enrollment, the contractor affirmed the initial determination (although without explicitly mentioning the actual effective date).  CMS Ex. 5.  Petitioner appealed.

Before me, CMS maintains that it received Petitioner's reenrollment application on April 19, 2018, so that is the effective date of its re-enrollment.  The problem is that CMS submitted no evidence of the date Petitioner submitted the application.  It refers to the reconsidered determination, but the contractor's conclusion is not evidence.  No evidence in this record establishes the date that Petitioner filed its subsequently-approved enrollment application.

In an order dated October 20, 2020, I directed CMS to submit, within ten days, a copy of the reenrollment application or similar evidence showing the date the application was filed.  CMS did not respond.

**Page 3**

On November 3, 2020, I issued an order to show cause, directing CMS to submit, no later than November 10, 2020, "the necessary evidence or to show cause why I should not remand this case to CMS for adequate development."  CMS did not respond.  Because I have no evidence establishing the date Petitioner submitted its enrollment application, I am unable to determine the correct effective date of Petitioner's Medicare enrollment.

Conclusion

Critical evidence is missing from this record, and CMS has declined to provide it.  I therefore remand this case to CMS to give the agency an opportunity to develop the record fully and properly so that I may decide it.  *See* 42 C.F.R. § 498.56(d).


          /s/
        Carolyn Cozad Hughes

                      Administrative Law Judge
      1. CMS's electronic process is referred to as PECOS (Provider Enrollment, Chain, and Ownership System). back to note 1 Back to top
    Contact HHS
    
                        
                                            
      
      
      Careers
    
                        
                                            
      
      
      HHS FAQs
    
                        
                                            
      
      
      Nondiscrimination NoticeHHS Archive
    
                        
                                            
      
      
      Accessibility Statement
    
                        
                                            
      
      
      Privacy Policy
    
                        
                                            
      
      
      Viewers & PlayersBudget/Performance
    
                        
                                            
      
      
      Inspector General
    
                        
                                            
      
      
      Web Site Disclaimers
    
                        
                                            
      
      
      EEO/No Fear ActFOIA
    
                        
                                            
      
      
      The White House
    
                        
                                            
      
      
      USA.gov
    
                        
                                            
      
      
      Vulnerability Disclosure Policy
        Sign Up for Email Updates

Receive the latest updates from the Secretary, Blogs, and News Releases.

Sign Up
  HHS Headquarters
          200 Independence Avenue, S.W.
                  Washington, D.C. 20201
                  Toll Free Call Center: 1-877-696-6775​ Disclaimer Policy: Links with this icon () mean that you are leaving the HHS website. The Department of Health and Human Services (HHS) cannot guarantee the accuracy of a non-federal website.
                  Linking to a non-federal website does not mean that HHS or its employees endorse the sponsors, information, or products presented on the website. HHS links outside of itself to provide you with further information.
                  You will be bound by the destination website's privacy policy and/or terms of service when you follow the link.
                  HHS is not responsible for Section 508 compliance (accessibility) on private websites. For more information on HHS's web notification policies, see Website Disclaimers.
 Continue
                  Go back