US · guidance
CMS Pub. 100-04, ch. 33, § 10.2.7
Provider Followed Guidance
The seventh condition that must be met is that the provider or supplier must have
followed the guidance provided by the Medicare contractor or by CMS.
The provider or supplier’s act or omission must have been in substantial, but not
necessarily complete, accord with the terms of the guidance. Deviation from the
guidance, if immaterial, would not necessarily be disqualifying. But even a small
deviation from the guidance, if material, could be disqualifying. In general, the greater
the specificity of the guidance, the greater must be the provider or supplier’s close
adherence to such guidance. In addition, the provider or supplier’s act or omission in
following the guidance must be either the same act or omission that is the basis of the
penalty or must be the direct, but not necessarily the immediately proximate cause of
such act or omission.
History
(Rev. 739, Issued: 11-01-05, Effective: 07-24-03, Implementation: 01-19-06)
Provenance
- Source
- cms.gov
- Retrieved
- 2026-08-25
- Edition
- iom-2026-08-25
- Content hash
8bbbff7af3b392bc47e26bc45a8e6f9a0ce098232647f4239ae1c2a0d842ab3c
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