Health Law Daily Wrap Up, ADMINISTRATION OF MEDICARE/MEDICAID PROGRAMS—DAB DECISIONS: Medicare enrollment effective date set to approved application receipt, not prior rejected filings, (Jun 1, 2026)

By WK Editorial Staff

CMS correctly based enrollment and reassignment effective dates on the only approved application, excluding earlier rejected submissions.

The HHS Departmental Appeals Board (DAB), Civil Remedies Division, determined that CMS properly established January 19, 2024, as the effective date of a physician’s Medicare enrollment and December 20, 2023, as the start of retrospective billing and reassignment of benefits. The decision addressed whether earlier, returned or rejected Medicare enrollment applications can support an earlier effective date. The administrative law judge (ALJ) affirmed CMS’s determination, concluding that only an application processed to approval can establish the effective date under applicable regulations, and that prior returned or rejected applications are not reviewable and cannot be relied upon to assign an earlier date (Allyshah Allahdina, M.D., DAB No. CR6845, Doc. No. C-24-554 (Feb. 26, 2026)).

The physician attempted multiple times to enroll in Medicare and reassign benefits, beginning with applications submitted in September 2023. These initial submissions were returned because the practice location fell within the jurisdiction of a different Medicare Administrative Contractor. Subsequent submissions were either incomplete or not timely corrected. Specifically, one application lacked a required authorized official’s signature and was rejected after the petitioner did not cure the deficiency within the regulatory timeframe. Another submission was rejected after the petitioner failed to provide a required reassignment form. These repeated deficiencies resulted in the formal rejection of all applications filed prior to January 19, 2024.

On January 19, 2024, the petitioner submitted new enrollment and reassignment applications. CMS received these applications on that same date and ultimately processed them to approval. CMS granted enrollment effective December 20, 2023, reflecting a 30-day period of retrospective billing privileges permitted under the regulations. Upon reconsideration, CMS maintained that December 20, 2023, was the correct effective date for both enrollment (via retrospective billing) and reassignment, explaining that previously rejected applications could not serve as a basis for an earlier date.

Suppliers, including physicians, enroll in the Medicare program to receive payment for covered services. Enrollment is effectuated through submission of an application containing all required information. Regulations establish that the effective date of enrollment is the later of the date of filing or the date services began at a new practice location. The “date of filing” is defined as the date the Medicare contractor receives an application that it ultimately processes to approval, and excludes applications that are returned or rejected before approval.

The physician argued that earlier applications should be considered because they were timely submitted and allegedly compliant with contractor requests. The physician also asserted reliance on representations from contractor personnel indicating that an earlier effective date would be assigned, and referenced an email purportedly showing that the applications were complete. The ALJ rejected these arguments noting that the referenced email was excluded because it was not properly submitted as an exhibit and lacked a showing of good cause for its late introduction. Additionally, even if considered, such communications could not override the regulatory requirements.

The administrative law judge also addressed the petitioner’s apparent request to treat earlier enrollment submissions independently from reassignment applications for billing purposes. The ALJ determined that such a request was inconsistent with regulations, which requires that enrollment applications be complete and approved to establish billing privileges. Partial or incomplete submissions cannot establish independent billing rights.

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