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Title 42: Public Health
CHAPTER IV: CENTERS FOR MEDICARE & MEDICAID SERVICES, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED)
SUBCHAPTER B: MEDICARE PROGRAM
PART 424: CONDITIONS FOR MEDICARE PAYMENT
Subpart P: Requirements for Establishing and Maintaining Medicare Billing Privileges
424.517 - Onsite review.
(a) CMS reserves the right, when deemed necessary, to perform onsite review of a provider or supplier to verify that the enrollment information submitted to CMS or its agents is accurate and to determine compliance with Medicare enrollment requirements. Site visits for enrollment purposes do not affect those site visits performed for establishing compliance with conditions of participation. Based upon the results of CMS's onsite review, the provider may be subject to denial or revocation of Medicare billing privileges as specified in § 424.530 or § 424.535 of this part.
(1) Medicare Part A providers. CMS determines, upon on-site review, that the provider meets either of the following conditions:
(i) Is unable to furnish Medicare-covered items or services.
(ii) Has failed to satisfy any of the Medicare enrollment requirements.
(2) Medicare Part B providers. CMS determines, upon review, that the supplier meets any of the following conditions:
(i) Is unable to furnish Medicare-covered items or services.
(ii) Has failed to satisfy any or all of the Medicare enrollment requirements.
(iii) Has failed to furnish Medicare covered items or services as required by the statute or regulations.
(b) [Reserved]
[73 FR 66940, Nov. 19, 2008]
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