CMS Pub. 100-04, ch. 30, § 150.7

Nonparticipating suppliers have the same rights to appeal the contractor’s determination

in an unassigned claim for medical equipment and supplies if the contractor denies

payment on the basis of §1862(a)(1) , §1834(a)(17)(B) , §1834(j)(1), or §1834(a)(15) of

the Act as they or participating suppliers have in assigned claims. These rights of appeal

also extend to determinations that a refund is required either because the supplier knew or

should have known that Medicare would not pay for the item or service, or because the

beneficiary was not properly informed in writing in advance that Medicare would not pay

or was unlikely to pay for the item or service. In addition to the beneficiary’s right to

appeal the contractor’s decision to deny payment on the basis of §1862(a)(1),

§1834(a)(17)(B), §1834(j)(1), or §1834(a)(15) of the Act, the beneficiary becomes a

party to any appeal request filed by the supplier. Since the beneficiary and the supplier

may have adverse interests in a decision regarding refund, it is essential to notify the

beneficiary in any case in which the supplier requests an appeal of the denial or asserts

that a refund is not required because one of the conditions in §150.5 is met. (See Chapter

29, “Appeals of this Claims Decision,” for detailed appeals instructions.)