Health Law Daily Wrap Up, ADMINISTRATION OF MEDICARE/MEDICAID PROGRAMS—DAB DECISIONS: CMS Correctly Set Physician’s Medicare Enrollment Reactivation Date, (May 12, 2026)

By Sara Cracau, J.D.

The Departmental Appeals Board confirmed that the physician’s Medicare reactivation date remained set at November 19, 2024, and affirmed that the ALJ could not modify this effective date.

The Departmental Appeals Board (DAB) of HHS has upheld in its entirety the decision of the CMS that determined that the effective date of reactivation of Medicare enrollment and billing privileges of a physician’s company was November 19, 2024. The physician failed to revalidate his Medicare enrollment record by the deadline provided by the Medicare administrative contractor and, therefore, his billing privileges were deactivated. Although he subsequently was able to reactivate his enrollment, there was a gap in his billing privileges from October 1 through November 18, 2024 which meant that he would not be paid for 353 claims totaling $219,140. The relevant regulation requires the effective date of reactivation of billing privileges to be the date the Medicare administrative contractor (MAC) or CMS received the Medicare enrollment application that was processed to approval. The ALJ has not authority to alter the reactivation date (Mokabberi MD, Inc. v. CMS, DAB No. CR6765, Doc. No. C-25-573 (Aug. 27, 2025)).

Background. On June 26, 2024, the MAC notified a physician that he needed to revalidate his company’s Medicare enrollment record by September 30, 2024 and warned that his failure to do so could result in deactivation of his billing privileges. The notice was sent to an address in Santa Ana, California. On October 2, 2024, the MAC informed the physician’s company that a stay was placed on the company’s enrollment record because the company did not respond to the June 26, 2024 revalidation request and the MAC warned that failure to revalidate could result in deactivation of billing privileges. The notice was sent to the Santa Ana address. On November 6, 202, the MAC notified the physician’s company that its billing privileges were deactivated effective October 1, 2024 because the company’s Medicare enrollment record had not been revalidated. The MAC also advised the physician’s company that it could submit a rebuttal within 15 calendar days of the date of the notice and advised how the provider could recover billing privileges by revalidating its Medicare enrollment record.

On November 19, 2024, the MAC received the physician company’s Medicare enrollment application to reactivate its deactivated billing number and the provider’s address was listed as being in Orange, California. On November 27, 2024, the MAC notified the physician that his revalidation/reactivation application was approved but there was a gap in billing privileges from October 1 through November 18, 2024 during which Medicare would not pay for services. He was notified that he had the right to request reconsideration within 65 days of the November 27, 2024 notice. He requested reconsideration and explained that his revalidation was not completed due to retirement of a staff member who had been responsible for credentialing and noting that as a result of the gap, he would not be paid for 353 claims, totaling $219,140. The MAC upheld its original determination and the physician requested a hearing. CMS filed for summary judgment and the physician opposed it.

Analysis. The DAB determined that there were no genuine issues of material fact and that CMS was entitled to summary judgment and that the date of reactivation of the physician’s company’s Medicare enrollment was proper. November 19, 2024 was the effective date of the physician company’s reactivation as that was the date that the MAC received the Medicare enrollment application that it could process to approval. Federal regulations establish a process for enrolling providers and suppliers in Medicare and pursuant to these regulations, if a provider does not revalidate his enrollment within 90 calendar days of receipt of the notice to revalidate. Failure to file a rebuttal within 15 calendar days from the date of the notice of deactivation results in a waiver of the right to submit a rebuttal. The MAC, CMS, or the ALJ has no discretion to alter the reactivation effective date.

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