CMS Pub. 100-08, ch. 10, § 10.4.9

(In the event of any inconsistency between the instructions in this section 10.4.9 and other

instructions in chapter 10, the 10.4.9 instructions take precedence if a stay of enrollment situation

is involved.)

A. Background

A stay of enrollment (or simply “stay”) under § 424.541 is a preliminary, interim status---prior to

any subsequent deactivation or revocation---that would represent, in a sense, a “pause” in

enrollment, during which the provider would nonetheless remain enrolled in Medicare. In this

vein, CMS would neither formally nor informally treat the stay as a sanction or adverse action

for purposes of Medicare enrollment.

Unless CMS explicitly instructs the contractor to do so (such as per section 10.4.9(D)

below), the contractor shall not: (i) initiate or impose a stay; or (ii) refer a potential stay

case to PEOG if the contractor believes a certain situation it has encountered may warrant

one.

B. Regulatory Requirements for Imposition -- Two-Step Test under § 424.541(a)(1)

As outlined in § 424.541(a)(1)(i) and (ii), there are two requirements for a stay’s implementation.

Specifically, the provider:

• Is non-compliant with at least one enrollment requirement in Title 42. (This includes

situations where its change of information or revalidation application was rejected under §

424.525(a)(1) or (2).)

AND

• Can remedy the non-compliance via the submission of, as applicable to the situation, a

Form CMS-855, Form CMS-20134, or Form CMS-588 change of information or revalidation

application (hereafter occasionally and collectively referenced as “the applicable CMS form” or

“ACF”.)

Examples of how this bright-line, two-pronged test would be met include:

• A provider failed to timely report a change in its address from 10 Smith Street to 20

Smith Street.

• A supplier did not respond to a revalidation request (or had its revalidation application

rejected) and the 90-day period for responding to the revalidation request has expired.

• A DMEPOS supplier did not report the deletion of a managing employee.

• A physician did not timely report a change in a practice location’s zip code.

• An MDPP supplier failed to timely report a change in the address of an organizational

owner.

• An IDTF failed to comply with a supplier standard in § 410.33(g) but compliance can be

reached by submitting an ACF.

In these illustrations, the provider failed to adhere to a reporting, revalidation, or supplier

standard requirement in Title 42 (the first prong of the § 424.541(a)(1) test) but could resume

compliance by submitting the applicable CMS form (the second prong). (It is important to

understand that if the type of non-compliance involved cannot be corrected via the submission of

an ACF, a stay cannot be imposed.) These are merely examples, however, and there are many

scenarios in which a stay could apply.

Examples of when the stay of enrollment test would not be met include:

• A provider’s owner has been convicted of a felony.

• A physician has lost a state medical license.

Although the first prong of the § 424.541(a)(1) test --- non-compliance --- has been met in these

situations, the provider cannot correct the non-compliance simply by submitting an ACF.

C. Important Facets of a Stay as Outlined in § 424.541

Section 424.541 also contains the following provisions:

1. Enrollment Status (§ 424.541(a)(2)(i)) – As previously mentioned, the provider remains

enrolled in Medicare during the stay.

2. Claims (§ 424.541(a)(2)(ii)):

Per § 424.541(a)(2)(ii)(A) – and except as stated in § 424.541(a)(2)(ii)(B) -- claims submitted by

the provider with dates of service within the stay period will be rejected.

Under § 424.541(a)(2)(ii)(B), claims submitted by the provider with dates of service within the

stay period are eligible for payment (assuming all other requirements for claim payment are met)

if:

• CMS or its contractor determines that the provider has resumed compliance with all

Medicare enrollment requirements in Title 42 (§ 424.541(a)(2)(ii)(B)(1)); and

• The stay ends before its original expiration date. (To illustrate, suppose CMS imposes a

stay period of 30 days. The claims described in § 424.541(a)(2)(ii)(B) would be payable if the

provider resumes compliance on or before the 30th day of the stay.)

To reiterate, the requirements of both § 424.541(a)(2)(ii)(B)(1) and (2) must be met for

payments to be made pursuant to § 424.541(a)(2)(ii)(B).

6. Maximum Duration and Effective Date of the Stay (§ 424.541(a)(3))

A stay of enrollment lasts no longer than 60 days from its effective date, which is, as applicable

and except as otherwise stated in this section 10.4.9, one of the following under § 424.541(a)(3):

• The date on which the provider’s or supplier’s non-compliance began; or

• The date on which the provider’s change of information or revalidation application was

rejected under 424.525.

(The prior instruction that the effective date of the stay is the postmark date of the stay

notification letter no longer applies except as otherwise noted.)

Again, a stay has a maximum length of 60 days and cannot be extended. Note, however, that

CMS can impose a stay of less than 60 days. It is not required that each assigned stay period be

60 days.

4. End-Date of the Stay (§ 424.541(a)(5)) – A stay ends on the earlier of the following dates:

• The date on which CMS or its contractor determines that the provider has resumed

compliance with all Medicare enrollment requirements in Title 42, OR

• The day after the imposed stay period expires.

For purposes of § 424.541(a)(5) ONLY:

++ The term “has resumed compliance” means the provider has submitted the ACF that

CMS requested the provider to submit in the stay notification letter. (See section

10.4.9(C)(5)(f) below for more information.) To illustrate:

• A provider receives a stay notification letter on March 1 because the provider had failed

to timely report an address change via the Form CMS-855B. The letter requests the provider to

submit this ACF. The provider does so on March 10. The stay thus ends on March 10.

• A provider receives a joint rejection-stay notification letter on June 1 because the

contractor finds grounds to reject its revalidation application. The provider submits another

revalidation application (which constitutes the ACF) on June 15. The stay ends on that day.

Note that the contractor need not have begun processing the ACF for a stay to be lifted. Even if

the application is later returned, rejected, or denied, the stay ceases on the date the application is

submitted.

++ For paper ACFs, the ACF is considered “submitted” on the date the contractor receives the

ACF (e.g., in its mailroom).

5. Additional Considerations

a. Adverse Action - A stay is not considered an adverse legal action of any kind.

b. Deactivations and Revocations - CMS always reserves the right to impose:

(i) A deactivation or revocation instead of a stay, even in cases of minor non-compliance. It should not be assumed that a stay will always be the first step in such

situations.

(ii) A deactivation prior to the expiration of the stay, in which case the deactivation ends

the stay

c. Multiple Stays and Extensions – CMS will neither extend a stay period beyond 60 days nor

apply a subsequent stay based on the same non-compliance (e.g., the provider failed to reach

compliance within the imposed/assigned stay period (e.g., within 15 days), so CMS

immediately applies another stay). Yet CMS may impose a stay multiple times against the

provider for separate instances of non-compliance (e.g., one stay in June 2024, another stay

in December 2025, and so forth).

d. Timeliness – Normal timeliness standards (as outlined in section 10.5 of this chapter) and

processing alternatives (outlined in chapter 10) apply when the contractor is processing the

ACF.

e. Applicable Forms and Transactions – As stated in § 424.541(a)(1), the types of ACFs for stay

purposes are the Form CMS-855A, Form CMS-855B, Form CMS-855I, Form CMS-855S,

Form CMS-20134, Form CMS-855O (though the CMS-855O will not involve claim

submissions, retroactive payments, etc.), and Form CMS-588. The applicable transactions

are limited to changes of information and revalidations. For purposes of the stay, however,

the term “changes of information” can include, at CMS’ discretion:

• Reassignment situations under the Form CMS-855I

• Changes of ownership (CHOWs)

f. Compliance – Except as stated or instructed otherwise by CMS, and strictly and solely for

purposes of lifting/ending a stay, compliance under §§ 424.541(a)(2)(ii)(B)(1) and (a)(5) is

reached when the provider submits the ACF. Once the stay expires, though, compliance

under Title 42 is only resumed consistent with existing policies (e.g., the contractor

approves the change of information).

g. Ordering/Certifying – A stay has no effect on a physician/practitioner’s ability to

order/certify/refer/prescribe services, items, or drugs.

h. Stay Periods – Except as instructed otherwise by CMS, all assigned stay periods for

revalidation non-responses or revalidation application rejections (see subsection (D) below)

will be 30 days (rather than 60 days). For the PEOG-directed stays described in subsection

(D)(2) below, PEOG will notify the contractor of the assigned stay period for that specific

case.

i. Revalidation Application Rejections and Associated Stay Effective Dates – For purposes of

the stay of enrollment concept, rejections of revalidation applications shall be treated largely

similarly to revalidation non-responses. This is particularly true with respect to timing, in

that in both situations a stay cannot be imposed until the expiration of the 90-day

revalidation response period.

Assume the contractor sends a revalidation request to the provider on April 1 with a due date

of June 30:

A. The provider submits the application on June 15. The application is rejected on July 31.

The contractor can impose a stay at this time because the 90-day revalidation period has

expired.

B. The provider submits the application on April 15. The application is rejected on May 31.

The contractor cannot impose a stay until July 1. If, between June 1 and June 30, the

provider:

1. Submits another revalidation application that is processed to approval, no stay shall

be imposed -- even if the approval came after the original 90-day period expired

(e.g., the contractor received the second revalidation application on June 15 and

approved it on July 31, 120 days after the commencement of the original revalidation

period on April 1).

2. Submits another revalidation application that the contractor rejects, the contractor

can impose a stay if the 90-day period has expired. If it has not, the contractor must

wait until it does.

3. Fails to submit another revalidation application, the contractor can impose a stay on

July 1 since the 90-day period has expired.

6. General Stay Process for Revalidation Non-Responses or Application Rejections

In general – and subject to the more specific scenarios described in section 10.4.9(D) -- the stay

process will work as follows in situations where: (i) the provider fails to submit a revalidation

application in response to a CMS/contractor revalidation request; or (ii) the provider’s

revalidation application is rejected.

Implementing the Stay - Within 10 days after the expiration of the period in which the provider

had to submit the revalidation application, the contractor shall: (a) send to the provider via

regular mail the applicable letter identified in section 10.7.20; and (b) switch the PECOS status

to “Approved – Stay of Enrollment”.

Removing the Stay if the Provider Submits the Revalidation Application During the Stay -

Within 10 days after the revalidation application is submitted, the contractor shall change the

PECOS status to “Approved – Remove Stay of Enrollment.”

Failure to Respond During the Allotted Timeframe – Within 10 days of the allotted

timeframe described below, the contractor shall deactivate the provider in accordance with CMS

directives.

(This also includes the contractor turning on and turning off claim rejection edits as warranted

(e.g., implementing the edits when the stay is imposed).)

Note that the above general process will be generally similar in cases where CMS directs the

contractor to impose a stay in a specific case, the principal exception being the timeframe for

contractor action in certain situations. These cases are addressed in subsections (D)(2)(a)

through (D)(2)(c) below.

D. Case Studies

This section 10.4.9(D) contains more detailed scenarios addressing how the stay process will

typically operate and the contractor’s required activities therein. (Except as otherwise indicated,

all days are calendar days.)

1. Non-Response to Revalidation Request

These scenarios assume the provider (Smith Health Care) failed to submit the requested

revalidation application within the required revalidation timeframe (RRT) – the last day of

which, for purposes of our examples, is February 27.

Scenario A – Revalidation Application Submitted During Stay Period and Is Approved

Step 1 –No later than 10 days after the expiration of the RRT, the contractor shall: (a) send to

Smith via regular mail the applicable letter identified in section 10.7.20; and (b) switch the

PECOS status to “Approved – Stay of Enrollment” effective February 28 (the day after the RRT

expired). This means Smith has until March 29 (or 30 days) to submit the revalidation

application. Claims for services furnished beginning February 28 to the end of the stay will be

rejected except as stated in § 424.541(a)(2)(ii)(B).

(If the contractor receives the revalidation application from Smith after the RRT expires but

before it mails the stay notification letter, the contractor can process the application as normal

without imposing a stay. Using our example in the previous paragraph, suppose Smith submits

its revalidation on March 3, before the contractor sends the stay notification letter. The

contractor can forgo imposing a stay even though Smith was out of compliance between

February 28 and March 2.)

Step 2 – Smith submits the revalidation application on March 16.

Step 3 – No later than 10 days after the revalidation application is submitted, the contractor shall

change the PECOS status to “Approved – Remove Stay of Enrollment” effective on the

submission date (March 16 if the application was submitted via PECOS). Claims for services

furnished between February 28 and March 16 (i.e., the duration of the stay) are therefore

payable.

Step 4 – The contractor processes the revalidation application to approval and takes all standard

actions related thereto (e.g., sends approval letter, switches PECOS record to “Approved”). No

further action needed.

Scenario B – Revalidation Application Not Submitted at All

Assume that Step 1 is the same as Step 1 in Scenario A.

Step 2 – Smith fails to submit the revalidation application by March 29, the last day of the stay

period. The contractor need take no action regarding the lifting of the stay (e.g., notifying the

provider of the stay’s cessation).

Step 3 – Within 10 days of the March 29 date (i.e., by April 8), the contractor shall: (a) change

the PECOS status to “Deactivated” effective the day after the RRT expired (or February 28); and

(b) take all other measures normally associated with a deactivation (e.g., send deactivation

letter).

Note that the deactivation effective date is retroactive to the date of the non-compliance (again,

February 28), or the date by which Smith was required to submit the revalidation application to

CMS. This means that even though the stay was lifted effective March 30 and claims furnished

on or after that date are thus payable, this will effectively be negated by the retroactive

deactivation in a manner akin to how retroactive deactivations currently operate.

Due to the provider’s failure to submit the application during the stay period, claims for services

furnished during the stay (February 28 – March 29) are not payable.

Scenario C – Revalidation Application Submitted During the Stay but Is Rejected

Assume Steps 1, 2, and 3 are the same as Steps 1, 2, and 3 in Scenario A.

Step 4 – The contractor determines that the revalidation application should be rejected.

Step 5 – The contractor shall:

• Process the rejection consistent with existing procedures.

• Within 10 days of sending the rejection letter: (a) change the PECOS status to

“Deactivated” effective the day after the RRT expired (or February 28); and (b) take all other

measures normally associated with a deactivation (e.g., send deactivation letter).

Scenario D – Revalidation Application Not Submitted During the Stay but Is Submitted

After the Stay Period Expires

Assume Step 1 is the same as Step 1 in Scenario A. (Note that the stay expired on March 29.)

Step 2 - Smith submits the revalidation application on April 3.

Step 3:

Step 3A - If the contractor receives the revalidation application before it mails the deactivation

letter (as described in Step 3 of Scenario B), the contractor can process the application as normal

without imposing a deactivation.

Step 3B – If the contractor receives the revalidation application after it mails the deactivation

letter, it shall process the application as a reactivation application.

Scenario E - Contractor Imposes Stay for Failure to Submit Requested Revalidation

Application and Provider Then Submits COI Rather Than Revalidation. Here, the

contractor:

(i) Shall not remove the stay. This is because the COI is not an ACF --- that is, it does not

address the cause of the stay, which is the failure to submit a revalidation application.

(ii) Shall follow the instructions in section 10.4.5.1(C) of Chapter 10 with respect to the COI

submission.

(iii) Shall develop for a revalidation application via any written means (e.g., e-mail but not

telephone). The provider shall have 30 additional days from the date the contractor received the

COI to submit the revalidation application. In no circumstance, however, shall this latter

revalidation timeframe exceed 60 days from the effective date of the stay. To illustrate, suppose

the stay’s effective date is June 1. The contractor receives the COI on July 2 before it proceeds

to a deactivation. (See Scenario D of section 10.4.9(D)(1).) The provider has until July 31

(rather than August 1) to submit the revalidation application.

2. PEOG-Directed Stays

The situations in this subsection (D)(2) only apply when PEOG directs the contractor via e-mail

to impose a stay. Except as otherwise instructed, the contractor need not notify PEOG that it has

imposed the stay, whether the provider submitted the ACF, whether and when a deactivation was

imposed, etc.

a. Ownership Discrepancies

PEOG may notify the contractor via e-mail to apply a stay against a particular provider due to

incorrect enrollment information pertaining to ownership; the provider must correct this data by

submitting an ACF. In such cases, the contractor shall follow the general stay procedures, steps,

and scenarios outlined in subsection (D)(1) above except as follows:

• Step 1 of Scenarios A, B, C, and D - Within 5 days of receiving this e-mail, the contractor

shall: (a) send to the provider via regular mail the letter identified in section 10.7.20(B); and (b)

switch the PECOS status to “Approved – Stay of Enrollment” effective the date that CMS directs

(or, if no date was directed, the date the stay notification letter was mailed).

• Step 3 of Scenarios B and D - Within 5 days after the expiration of the 30-day stay

period, the contractor shall: (a) change the PECOS status to “Deactivated” effective on the stay

effective date that CMS directed (or, if no date was directed, the date the stay notification letter

was mailed); and (b) take all other measures normally associated with a deactivation (e.g., send

deactivation letter).

• Step 5 of Scenario C - Within 5 days of sending the rejection letter, the contractor shall:

(a) change the PECOS status to “Deactivated” effective on the stay effective date that CMS

directed (or, if no date was directed, the date the stay notification letter was mailed); and (b)

take all other measures normally associated with a deactivation (e.g., send deactivation letter).

• Step 3B of Scenario D - If the contractor receives the ACF after it mails the deactivation

letter, it shall request the submission of or develop for a reactivation application.

To illustrate the first three exceptions, suppose the contractor receives an e-mail from PEOG on

August 1 directing it to impose a stay on Provider X because X’s ownership data is incorrect. If

this were a revalidation situation, the contractor would have 10 days (or until August 11) to

complete Step 1. Here, however, the contractor must complete Step 1 by August 6.

Now assume the contractor finishes Step 1 on August 4. Per CMS direction, the stay is effective

July 30 (the date the provider’s non-compliance began), is for 30 days, and thus ends on August

29. Provider X fails to submit the ACF during that period. The contractor must complete Step 3

by September 3 (rather than September 8). If X timely submitted the ACF but the contractor

rejects it and sends the rejection letter on September 20, the contractor must complete Step 5 of

Scenario C by September 25.

In sum, the only material differences between the general procedures in subsections (D)(1) and

(D)(2)(a) are:

• The timeframes for contractor action (10 days vs. 5 days)

• (D)(1) addresses revalidations --- for which no prior notification from PEOG is needed to

impose a stay --- whereas (D)(2)(a) applies only to ownership discrepancies and requires said

notification from PEOG.

• In (D)(1) cases, any deactivation effective date is retroactive to the day after the RRT’s

expiration. For (D)(2)(a) situations, the deactivation effective date is retroactive to the stay

effective date that CMS directed (or, if no date was directed, the date the stay notification letter

was mailed).

b. Immediate Imposition

Situations could occur when PEOG directs the contractor via e-mail to immediately impose a

stay. Here, and except if PEOG directs otherwise:

• Step 1 of Scenarios A, B, C, and D - Within 1 business day of receiving this e-mail, the

contractor shall: (a) send to the provider via regular mail the letter identified in section

10.7.20(B); and (b) switch the PECOS status to “Approved – Stay of Enrollment” effective the

date that CMS directs (or, if no date was directed, the date the stay notification letter was

mailed).

• Step 3 of Scenarios B and D - Within 1 business day after the expiration of the 30-day

stay period, the contractor shall -- (a) change the PECOS status to “Deactivated” effective on the

stay effective date that CMS directed (or, if no date was directed, the date the stay notification

letter was mailed); and (b) take all other measures normally associated with a deactivation (e.g.,

send deactivation letter).

• Step 5 of Scenario C - Within 1 business day of sending the rejection letter, the

contractor shall: (a) change the PECOS status to “Deactivated” effective on the stay effective

date that CMS directed (or, if no date was directed, the date the stay notification letter was

mailed); and (b) take all other measures normally associated with a deactivation (e.g., send

deactivation letter).

• Step 3B of Scenario D - If the contractor receives the ACF after it mails the deactivation

letter, it shall request the submission of or develop for a reactivation application.

Aside from the above timeframes, the contractor shall follow the general procedures, steps, and

scenarios outlined in subsection (D)(1) above.

c. All Other PEOG-Directed Stays

For all PEOG-directed stays other than those described in subsections (D)(2)(a) and (b)

(including -- as indicated in section 10.4.1.4.3(E)(1)(a) -- situations where the

provider’s/supplier’s CHOW or change of information submission is rejected), the following

apply:

• As with revalidations, the contractor has 10 days to undertake the actions described in

Steps 1, 3 (Scenarios B and D), and 5 (Scenario C).

• Step 3B of Scenario D - If the contractor receives the ACF after it mails the deactivation

letter, it shall request the submission of or develop for a reactivation application.

d. Additional Case Studies Where PEOG Directs a Stay

This subsection (D)(2)(d) identifies certain scenarios in which PEOG may direct a stay and how

the contractor should handle the situation. These scenarios are in addition to, and not in lieu of,

others that are addressed in section 10.4.9(D).

(i) ACF Received Before the Stay’s Imposition

Assume CMS instructs the contractor to impose a stay in Instance (D)(2)(a), (b), or (c)

above. Before the contractor mails the stay notification letter to the provider, however, the

contractor receives the ACF (as the term ACF is defined/explained in this section 10.4.9). Here:

1. The contractor shall not impose the PEOG-directed stay and shall instead process the

ACF normally (including development as needed).

2. Notwithstanding the language in the opening paragraph of subsection (D)(2) regarding

PEOG notification, the contractor shall inform its PEOG BFL via e-mail that the stay was

not implemented and why. This e-mail shall be sent no later than 7 calendar days after

the contractor received the ACF.

(ii) ACF Submitted During the Stay

Assume Scenario (D)(2)(d)(i) above but further assume that the provider submits the ACF after

the stay is implemented. Here, the contractor shall generally follow Step 3 in Scenario A of

subsection (D)(1) – specifically: (1) change the PECOS status to “Approved – Remove Stay of

Enrollment” effective on the submission date; and (2) process the ACF normally (including

development as needed).

If the ACF is approved, the contractor shall generally follow Step 4 in Scenario A of subsection

(D)(1).

If the ACF is rejected, the contractor shall follow Step 5 in Scenario C of subsection (D)(1)

(though -- as applicable depending on the type of stay involved (e.g., ownership discrepancy) --

modified as described in subsection (D)(2)(a), (b), or (c)) Note that in Step 5, the stay does not

go back into effect when the application is rejected and then remain intact until the originally

assigned stay period (e.g., 30 days) expires. Rather, the contractor (as described in Step 5) shall

proceed to a deactivation without reimposing the stay.

(iii) Contractor Receives COI Before Mailing the Stay Notification Letter

(a) The submitted COI is an ACF, meaning -- as explained in section 10.4.9(B) -- it can remedy

the non-compliance in question via the form submission. Here:

1. The contractor shall not impose the stay and shall instead process the ACF normally

(including development as needed).

2. Notwithstanding the language in the opening paragraph of subsection (D)(2) regarding

PEOG notification, the contractor shall inform its PEOG BFL via e-mail that the stay was

not implemented and why. This e-mail shall be sent no later than 7 calendar days after

the contractor received the ACF.

(b) The submitted COI is not an ACF. Here:

(1) The contractor shall impose the stay as directed, using the procedures outlined in section

10.4.9.

(2) The contractor shall develop the COI for the information that will remedy the non-compliance (i.e., the missing/deficient/incorrect ACF data that triggered the stay

directive). This means the ACF information, to the maximum extent possible, should be

furnished on/via the COI and not through a separate ACF submission. However, the

contractor shall accept and process the ACF if it is submitted separate from the COI; in

this situation, the contractor shall merge the COI and ACF into a single submission. Note

that the processing time clock does not stop when developing the COI for the ACF data.

3. In its stay notification letter – which, for purposes of this scenario, will also constitute a

development letter -- the contractor shall request that the provider update its COI with the

ACF. (The specific verbiage lies within the contractor’s discretion.) If the COI itself

also requires development (e.g., data is incorrect), the letter shall also explain the

information to be added, remedied, etc.

4. Consistent with current policy (assuming the designated stay period (e.g., 30 days) has

not expired), the stay ends on the date the provider submits the ACF – either via an

update to the COI or as a separate submission.

5. Final determination

• If the submitted ACF data cannot be approved (irrespective of whether the COI data can),

the contractor shall proceed to a deactivation consistent with the instructions in subsection

(D)(2). The COI data will ostensibly be captured via the provider’s reactivation application.

• If the submitted ACF data can be approved but the COI information cannot, the

contractor shall contact its PEOG BFL for guidance on how the matter should be handled.

E. Returns

In any situation where the contractor determines the submitted ACF – be it a revalidation, COI,

etc. -- should be returned, the contractor shall treat the matter as it would a rejected ACF. (See

Steps 4 and 5 of Scenario C of subsection (D)(1).)

F. Other Scenarios

The contractor may encounter stay situations not explicitly identified in subsection (D) above. In

such situations, the contractor shall -- to the maximum extent possible -- still follow the general

processes and basic steps outlined in the (D)(1) and (2) scenario(s) most applicable to the case

the contractor is handling. If the contractor nonetheless needs additional guidance, it shall

contact its PEOG BFL for guidance.

G. Letters

The contractor shall send all stay notification letters via hard-copy mail and via e-mail (if a valid

email address is available); the contractor should also send the notice via fax if a valid fax

number is available. All notifications shall be saved in PDF format, and all notification letters

shall be mailed on the same date listed on the letter.

H. Rebuttals

See section 10.4.9.1 of this chapter for information concerning rebuttals of stays of enrollment.

I. NPE and DME MAC Interaction

The NPEs and the DME MACs shall interact, coordinate, and communicate with each other in

stay situations consistent with CMS instructions and in instances generally akin to those

involving deactivations. This could include, for example:

• The NPE notifying the applicable DME MAC of the imposition or lifting of a stay and

any subsequent deactivation.

• Upon being informed of a stay by the NPE, the DME MAC holding payment for services

furnished during the stay period.

J. Stay Expires – Deactivation Effective Date

To reiterate, if a stay expires and a deactivation immediately follows, the deactivation effective

date is the date on which the provider first became non-compliant. This is consistent with the

guidance in section 10.4.9(D).

K. Removal of A/R Code

As indicated in section 10.4.9, the contractor shall remove the stay of enrollment (e.g., A/R 350

or the Part A PARM) from the provider’s file upon:

• Deactivation of the enrollment if the provider did not submit an ACF during the stay

period.

• Submission of the ACF after the stay period has ended but prior to deactivation.

(Other situations when the stay should be lifted are addressed in section 10.4.9.)