US · guidance
CMS Pub. 100-04, ch. 6, § 50.7
Retroactive Removal of Sanctions
PM AB-01-131
Occasionally, resolution between the State Agency and the SNF is reached after the
payment ban has been imposed, and the ban is removed retroactive to its effective
date. If bills were denied before notice was received that the ban had been reversed, they
should be reprocessed and paid. When reprocessing bills, MDS assessments are needed
to support the case-mix classification group billed.
Beneficiaries and providers may request A/B MACs (A) to reopen and process bills
denied as a result of a misunderstanding of the sanction requirements. These reopenings
shall be done on a request basis only, and will be limited to service dates on and after
January 1, 1999.
History
(Rev. 4409, Issued: 10-04- 19, Effective: 11-05-19, Implementation: 11-05-19)
Provenance
- Source
- cms.gov
- Retrieved
- 2026-08-25
- Edition
- iom-2026-08-25
- Content hash
482ea576face02961e24962d4fc08c490fe4c85bef35c68c8d3f7207693f0c54
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