CMS Pub. 100-08, ch. 8, § 8.3.2.5

The UPIC shall recommend to CPI that the payment suspension be terminated prior to

the payment suspension expiring. The UPIC shall initiate this recommendation by

completing the “Termination Recommendation Information” section of the AAR and

submit it via the UCM at least 14 calendar days prior to the anticipated payment

suspension expiration date. No action associated with the termination shall be taken

without the explicit approval of CPI. The UPIC shall prepare a “draft termination notice”

(in accordance with section 8.3.2.2 of this chapter) and send it, along with a draft

overpayment notice(s) and any other supportive information, to CPI for approval.

The UPIC shall recommend to CPI that a suspension be terminated when any of the

following occur:

• The basis for the payment suspension action was that an overpayment may

exist or money to be paid may be incorrect, and the UPIC has determined the

amount of the overpayment, if any.

• The basis for the payment suspension action was that a credible allegation of

fraud exists against the provider, and the amount of the overpayment has

been determined.

• The basis for the payment suspension action was that payments to be made

may not be correct, and the UPIC has determined that current payments to be

made are now correct, and any associated overpayments have been

determined.

• The basis for the payment suspension action was that the provider failed to

furnish records, and the provider has now submitted all appropriate requested

records.

When the payment suspension is terminated, the disposition of the withheld funds shall

be achieved in accordance with 42 CFR §405.372(e) and the payment suspension edit

withholding the provider’s funds is removed in the MAC system accordingly, within 60

days. Upon approval of the termination notice by CPI, the UPIC shall provide a copy of

the signed notice via the UCM to CPI.