Understanding Effective Dates for Provider Termination in Medicare

 Effective date of provider termination

 Voluntary Termination

 A provider, as per 42 CFR 489.52, may terminate its participation agreement in the Medicare programme by sending to CMS: (i) a written notice of the date an agreement termination is proposed to take effect and (ii) a proposal for a date on which such termination is to take effect. Approval of the date proposed by the provider is granted by Medicare or a different one (no later than 6 months following the provider’s notice) is set.

 The effective date of the termination, if earlier than six months following receipt by CMS of the provider’s notice of its intent to terminate, may be the date on which CMS determines termination on that date would not promote the delivery of quality healthcare.

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

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

 If the provider delivers to the FI a written notice of its intent to terminate its agreement, the FI shall forward the notice to the CMS RO; except that if a notice is delivered to the FI by the provider, the date of receipt by the FI shall be the filing date in determining what is considered the date of termination. 

 Upon learning from sources other than the FI of a provider’s request to terminate participation in the program, the RO notifies the FI promptly of the request and its status. When a notice of termination is filed, the FI, in turn, – as appropriate – takes preliminary steps to arrange for filing of the cost report and – in the case of providers who have been the beneficiaries of interim payments or accelerated payments – for refunds or corrections of such overpayments; and, for providers who are currently financed, for refunds or corrections of such payments. Final notice of termination is sent from the RO to the FI. The RO transfers to the FI, by Form CMS-2007, all proper written notices of termination filed during the cost reporting period.

 Once the termination date has been specified, the RO informs the supplier to provide written notice to the public that it is voluntarily terminating its supplier agreement. Such notification is to be published in newspapers with the largest circulation in its locality as soon as possible but not earlier than l5 days before the effective termination date. A supplier who wishes to voluntarily terminate its supplier agreement must also submit a Form CMS-855A with the FI requesting that the FI terminate its Medicare billing number.