Provider Termination Process in Medicare Program

Effective date of provider termination

 Voluntary Termination

 A Medicare provider who seeks to terminate its participation in the Medicare programme, as required by 42 CFR 489.52, must submit to the CMS a written notice of termination, and state the date the termination will take effect. The CMS may accept the provider’s proposed date or elect any date, not more than six months after the date of the provider’s notice. 42 CFR 489.52 There are various situations in which an administrator seeks to revoke franchise or rescind a contract. An example is where a franchise is delegated for a term of years expressly subject to revocation upon the occurrence of any ‘default of the grantee’.

 Effective date of termination may be less than six months from the date CMS receives the provider’s notice of its intent to terminate if CMS determines that termination on that date would not: 6.015-10 Exit.

• Unduly disrupt the furnishing of services to the community; or

• Otherwise interfere with the effective and efficient administration of the Medicare program.

 Upon receipt, if a written FI exit notice is received by the FI, the FI will forward the notice to the CMS RO and the date the FI received it will be the filing date of the notice and used to determine the date of termination.

 If the RO receives notice from another source that the provider wishes to discontinue its participation in the program, the RO promptly advises the FI of its status and keeps the FI informed during the progression of the provider’s request. The FI, as needed, takes interim steps, such as making preliminary arrangements for the filing of the cost report and adjusting any interim payments or accelerated payments of current financing payments to prevent overpayments. The RO formally gives final notice of the provider’s termination of the agreement by sending a duplex communication on Form CMS-2007 to the FI.

 Upon selecting the effective termination date, the RO must notify the PRO that it is voluntarily terminating its provider agreement. The PRO must provide a public notice stating its intent to terminate its Medicare provider agreement. The notice must be published at least once in the newspaper with the largest circulation in the area served by the PRO and at least once in any other local newspaper with substantial circulation in the same area. The first notice must be published as soon as possible, but no later than 15 days before the effective termination date. Should a provider wish to terminate its provider agreement, it must file a Form CMS-855A with the FI for the voluntary termination of the Medicare billing number.