CMS Pub. 100-08, ch. 10, § 10.3.1.5.5

If the contractor determines that grounds exist for revoking the supplier’s Form CMS-855O

enrollment, it shall:

(i) Switch the supplier’s PECOS record to a “revoked” status

(ii) End-date the PECOS record

(iii) Send a letter via certified mail to the supplier stating that the Form CMS-855O enrollment

has been revoked. The letter shall follow the format outlined in section 10.7.8 of this chapter.

Grounds for revoking the supplier’s Form CMS-855O enrollment are as follows:

(i) The supplier is no longer of a type that is eligible to order or certify

(ii) The supplier no longer meets the licensure, certification, or educational requirements for the

supplier type

(iii) The supplier is excluded per the MED and/or debarred per the SAM

For purposes of the Form CMS-855O only, the term “revocation” effectively means that:

(i) The supplier may no longer order or certify Medicare services based on having completed the

Form CMS-855O process.

(ii) If the supplier wishes to submit another Form CMS-855O, this must be done as an initial

applicant.

There are appeal rights associated with the revocation of a supplier’s Form CMS-855O

enrollment.