§ 424.500 Scope
§ 424.502 Definitions
§ 424.505 Basic enrollment requirement
§ 424.506 National Provider Identifier (NPI) on all enrollment applications and claims
§ 424.507 Ordering covered items and services for Medicare beneficiaries
§ 424.510 Requirements for enrolling in the Medicare program
§ 424.514 Application fee
§ 424.515 Requirements for reporting changes and updates to, and the periodic revalidation of Medicare enrollment information
§ 424.516 Additional provider and supplier requirements for enrolling and maintaining active enrollment status in the Medicare program
§ 424.517 Onsite review
§ 424.518 Screening levels for Medicare providers and suppliers
§ 424.519 Disclosure of affiliations
§ 424.520 Effective date of Medicare billing privileges
§ 424.521 Request for payment by certain provider and supplier types
§ 424.522 Additional effective dates
§ 424.525 Rejection of a provider’s or supplier’s application for Medicare enrollment
§ 424.526 Return of a provider’s or supplier’s enrollment application
§ 424.527 Provisional period of enhanced oversight
§ 424.530 Denial of enrollment in the Medicare program
§ 424.535 Revocation of enrollment in the Medicare program
§ 424.540 Deactivation of Medicare billing privileges
§ 424.541 Stay of enrollment
§ 424.542 Prohibition on ordering, certifying, referring, or prescribing based on felony conviction
§ 424.545 Provider and supplier appeal rights
§ 424.546 Deactivation rebuttals
§ 424.550 Prohibitions on the sale or transfer of billing privileges
§ 424.555 Payment liability
§ 424.565 Overpayment
§ 424.570 Moratoria on newly enrolling Medicare providers and suppliers
§ 424.575 Rural emergency hospitals

Terms Used In CFR > Title 42 > Chapter IV > Subchapter B > Part 424 > Subpart P - Requirements for Establishing and Maintaining Medicare Billing Privileges

  • Amendment: A proposal to alter the text of a pending bill or other measure by striking out some of it, by inserting new language, or both. Before an amendment becomes part of the measure, thelegislature must agree to it.
  • Appeal: A request made after a trial, asking another court (usually the court of appeals) to decide whether the trial was conducted properly. To make such a request is "to appeal" or "to take an appeal." One who appeals is called the appellant.
  • Bankruptcy: Refers to statutes and judicial proceedings involving persons or businesses that cannot pay their debts and seek the assistance of the court in getting a fresh start. Under the protection of the bankruptcy court, debtors may discharge their debts, perhaps by paying a portion of each debt. Bankruptcy judges preside over these proceedings.
  • Beneficiary: A person who is entitled to receive the benefits or proceeds of a will, trust, insurance policy, retirement plan, annuity, or other contract. Source: OCC
  • Continuance: Putting off of a hearing ot trial until a later time.
  • Contract: A legal written agreement that becomes binding when signed.
  • Conviction: A judgement of guilt against a criminal defendant.
  • Corporation: A legal entity owned by the holders of shares of stock that have been issued, and that can own, receive, and transfer property, and carry on business in its own name.
  • Electronic funds transfer: The transfer of money between accounts by consumer electronic systems-such as automated teller machines (ATMs) and electronic payment of bills-rather than by check or cash. (Wire transfers, checks, drafts, and paper instruments do not fall into this category.) Source: OCC
  • Embezzlement: In most states, embezzlement is defined as theft/larceny of assets (money or property) by a person in a position of trust or responsibility over those assets. Embezzlement typically occurs in the employment and corporate settings. Source: OCC
  • Evidence: Information presented in testimony or in documents that is used to persuade the fact finder (judge or jury) to decide the case for one side or the other.
  • Fraud: Intentional deception resulting in injury to another.
  • organization: means the enrolling entity as identified by its legal business name and tax identification number. See 42 CFR 424.502
  • Oversight: Committee review of the activities of a Federal agency or program.
  • Partnership: A voluntary contract between two or more persons to pool some or all of their assets into a business, with the agreement that there will be a proportional sharing of profits and losses.
  • Settlement: Parties to a lawsuit resolve their difference without having a trial. Settlements often involve the payment of compensation by one party in satisfaction of the other party's claims.
  • Statute: A law passed by a legislature.
  • User fees: Fees charged to users of goods or services provided by the government. In levying or authorizing these fees, the legislature determines whether the revenue should go into the treasury or should be available to the agency providing the goods or services.