CMS Pub. 100-08, ch. 8, § 8.3.2.2.2

The UPIC shall prepare a “draft notice” (in accordance with section 8.3.2.2 of this

chapter) and send it, along with the recommendation and any other supportive

information, to CPI for approval. The draft notice shall include, at a minimum:

• The date the payment suspension action will be or has been imposed;

• How long the suspension is expected to be in effect (NOTE: All payment suspensions

shall be established in 180 calendar day increments.);

• The reason for suspending payment. (For fraud suspensions, the UPIC shall include

the rationale to justify the action being taken.);

• In most notices, the UPIC shall identify and describe at least five example claims that

are associated with the reason for the payment suspension, if available. The claim

examples are to be the most current claims available unless otherwise directed by CMS.

The notice shall only reference the example claim control number, the amount of

payment, and the date of service;

• The extent of the payment suspension (i.e., 100 percent payment suspension or partial

payment suspension, where less than 100 percent of payments are withheld);

• The payment suspension action is not appealable;

• CMS/CPI has approved implementation of the payment suspension;

• Documentation that the provider has been given the opportunity to submit a rebuttal

statement within 15 calendar days of notification; and

• An address for the provider to mail the rebuttal.