CMS Pub. 100-04, ch. 6, § 50.6

The A/B MACs (A) will receive notices from the CMS Regional Office when sanctions

have been imposed or lifted and in some cases when sanctions are proposed. The CMS’

primary objective is always to bring the facility into compliance. In many cases,

enforcement activity does not go beyond the notice of intent. A/B MACs (A) shall

initiate action only when notified that sanctions have been imposed.

Upon notification that a sanction is imposed, A/B MACs (A) shall identify claims

affected with admission dates on and after the effective date of the sanction.

Overpayments for claims erroneously paid should be recovered and CWF properly

updated to reflect the payment ban action. Claims for new admissions should be denied

from the date of admission through the last date of the sanction period.

In addition, A/B MACs (A) shall determine whether claims with admission dates after the

effective date of the sanctions qualify for readmission status, as defined in the previous

sections, and are not subject to a payment ban. A/B MACs (A) shall bypass local

payment ban edits for claims that are not subject to a payment ban when dates associated

with occurrence span code 80, Prior Same-SNF stay for payment ban purposes, indicates

the beneficiary resided in the SNF prior to the imposition of the ban. (See §50.2 above

for further payment ban bypassing criteria for hospitalizations and LOAs).