HI 00208.065 Terminations

A. Arranging for public notice of involuntary termination

When a provider is involuntarily terminated, the HSQ RO contacts the servicing DO to arrange for the publication of a notice in the local newspaper(s) announcing the termination and the reasons for it. (A newspaper notice is optional for independent laboratories and certain other suppliers of services.)

It is the DO's responsibility to contact the local newspaper(s) and arrange for publication of the notice. The DO receives from the HSQ RO the text of the public notice and an original and one copy of SF-1143, Advertising Order, which should be given to the publisher. Since many aged people have poor vision, the notice should be in print larger than standard newsprint. The advertisement should be one or two columns totalling not less than 1 1/2 column inches (1 column ×3 1/2 inches, or 2 columns ×1 3/ 4 inches) and not more than 8 column inches.

Inform the publisher that one of the following options may be used to claim reimbursement:

  1. The back of the original SF-1143 may be completed with either a copy of the advertisement attached or a certification made in the space provided on the form; or

  2. Any billing form may be substituted with a copy of the advertisement or a certification attached to the original SF-1143.

Instruct the publisher to mail the original of the SF-1143 and attachments to the HSQ RO at the address given near the bottom of the form. The publisher may retain the copy for his files. Questions relating to the public notice should be referred to the HSQ RO.

B. Effects of an involuntary termination on patients

For hospitals and skilled nursing home patients, the Health Insurance program will not make payment for services furnished on or after the effective date of termination. For patients admitted prior to the date of termination, payment may continue to be made for up to 30 days for services furnished on or after the date of termination. The provider being terminated is required to submit a list to the intermediary showing the names and health insurance claim numbers for patients admitted prior to the date of termination and who are still patients on the date of termination. If hospital and skilled nursing home services are needed beyond the 30 day period, the patient must be transferred to an approved provider in order for Medicare/Medicaid payments to continue beyond the 30 days.

For home health agencies, the Health Insurance program will not make payment for services furnished patients whose plan of treatment was established on or after the date of termination. For patients whose plan of treatment was established before the date of termination, payment will be made until the end of the plan of treatment or to the end of the calendar year, whichever is earlier.

For a supplier of services (an independent laboratory, portable x-ray, out-patient physical therapy, or speech pathology), the effective date of termination is the first day of the first month which is at least 15 days after the date the notice of termination is mailed. No payment will be made for services rendered on or after the effective date of the termination.

C. Appeal rights of terminated providers/suppliers

A provider or supplier which does not believe the termination decision is correct has the right to request a hearing before an administrative law judge. The request for a hearing should be filed with the RO within 60 days of the date of receipt of the decision of termination. Should any request for reconsideration, hearing, appeal, or review of a termination be filed in the DO, forward it to the HSQ RO.


To Link to this section - Use this URL:
http://policy.ssa.gov/poms.nsf/lnx/0600208065
HI 00208.065 - Terminations - 04/07/2015
Batch run: 04/07/2015
Rev:04/07/2015