There are numerous adverse actions that can be taken against a provider’s Medicare ordering and referring or billing privileges. In general, however, deactivation is not considered such an “adverse action” that will reflect on the providers PECOS; however, it does “stop” your ability to use your Medicare privileges. If you have experienced an adverse action on your privileges, such as your privileges being revoked or excluded, please investigate yourself or call counsel to understand the rules and strict deadlines around what to do to preserve your right to appeal the decision. This blog post covers “deactivation” only. If you have questions regarding this blog post or wish to discuss your Medicare privileges, you may contact us at (404) 685-1662 (Atlanta) or (706) 722-7886 (Augusta), or by email, info@littlehealthlaw.com. You may also learn more about our law firm by visiting www.littlehealthlaw.com.
What is a Deactivation of Medicare Privileges?
The Medicare code defines “Deactivate” as “the provider or supplier’s billing privileges were stopped but can be restored upon the submission of updated information.” 42 C.F.R. § 424.502. Importantly, “[t]he deactivation of Medicare billing privileges does not have any effect on a provider’s or supplier’s participation agreement or any conditions of participation,” but “[a] provider or supplier may not receive payment for services or items furnished while deactivated.” 42 C.F.R. §§ 424.540(c), (e). Generally, on PECOS, the deactivation will not appear as an adverse action, but may appear in the history tab.
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