When CMS or a Medicare Administrative Contractor (MAC) suspends your practice’s Medicare payments under 42 CFR 405.371, that determination cannot be appealed through the administrative appeals process (42 CFR 405.375(c)). Under 42 CFR 405.374(a), you have at least 15 calendar days following the date of notification to submit a written rebuttal statement, and under 42 CFR 405.375(a) CMS or the contractor must issue a determination within 15 calendar days from the date your statement is received.
Read the five governing sections of 42 CFR Part 405, Subpart C before writing a single line to your Medicare contractor.
CMS or a Medicare contractor withholds payment — in whole or in part — when it possesses reliable information that an overpayment exists or that payments to be made may not be correct (§ 405.371(a)(1)), or after consulting HHS-OIG and, as appropriate, the Department of Justice on a credible allegation of fraud (§ 405.371(a)(2)). Claims continue to process, but funds are held.
Read 42 CFR 405.371 on eCFR →“A determination made under paragraph (a) of this section is not an initial determination and is not appealable.” Unlike an overpayment demand, a payment suspension cannot be taken to redetermination, a Qualified Independent Contractor, or an Administrative Law Judge while the suspension is running.
Read 42 CFR 405.375 on eCFR →When prior notice is given, “the provider or supplier has at least 15 days following the date of notification to submit the statement” (§ 405.374(a)), unless shortened or extended for cause under § 405.374(b). When a suspension takes effect without prior notice under § 405.372(a)(2)–(4), the contractor must give an opportunity to submit a rebuttal statement once the suspension is in effect (§ 405.372(b)(2)).
Read 42 CFR 405.374 on eCFR →CMS, the intermediary, or the carrier “must within 15 days, from the date the statement is received, consider the statement (including any pertinent evidence submitted)” and send written notice containing “specific findings on the conditions upon which the suspension is initiated, continued, or removed and an explanatory statement of the determination.”
Read 42 CFR 405.375 on eCFR →A suspension does not have to freeze 100% of a practice’s revenue. Section 405.371(a) authorizes payments to be “Suspended, in whole or in part,” and 42 CFR 405.371(b)(1) lists four good-cause grounds on which CMS may decline to suspend payments or narrow/discontinue a suspension in whole or in part:
Both 42 CFR 405.374(a) and 42 CFR 405.375(a) state “15 days” — calendar days, without excluding weekends or holidays. Enter the date on your notice to compute your rebuttal due date and CMS’s 15-day determination deadline in your browser.
15 calendar days after 2026-10-23. Because 2026-11-07 falls on a weekend, deliver by Friday 2026-11-06 so the statement is in hand before day 15 ends. Also check the notice letter in case a shorter or extended period was set for cause under § 405.374(b).
15 calendar days from the date CMS or the contractor receives your rebuttal (2026-11-07 if received on day-15; earliest 2026-11-07 if received on the notice date). Submitting a rebuttal does not delay the suspension beyond the date stated in the notice.
180 calendar days from 2026-10-23. Non-fraud suspensions are limited to 180 days (§ 405.372(d)(1), with one possible 180-day extension under (d)(2)). For credible allegations of fraud, CMS must evaluate good cause and request OIG/law-enforcement certification every 180 days (§ 405.371(b)(2)).
60 calendar days after identification (§ 401.305(b)(1)(i)), or suspended up to 180 calendar days (2027-04-21) while conducting a timely, good-faith investigation of related overpayments (§ 401.305(b)(3)(ii)).
Programmatic access (same math, keyless GET): GET /api/v1/suspension/deadlines?notice=2026-10-23 · Open-source package & SKILL.md: packages/suspension-kit/ (Apache-2.0)
Answer Yes or No for each habit below. Your answers stay in memory in this tab and are never transmitted or saved. The result is a plain list of items to fix with their primary citations — never a score, percentage, or risk number.
For every patient on remote monitoring, does the chart document an established prior visit with the practice (in-person or telehealth) and all three service components: patient education and device setup, a connected device that transmits health data, and ongoing treatment management using those data?
“Original Medicare requires medical practices to have an established relationship with the enrollee before billing for remote patient monitoring. ... We developed several measures to monitor billing for remote patient monitoring, including: billing for a high proportion of enrollees who have no prior history with the medical practice; and billing for multiple monitoring devices a month for an enrollee.” — HHS-OIG Report OEI-02-23-00261, pp. 6–8 & Footnote 8 (read 2026-10-23)
Before billing remote monitoring for a month, do you verify at intake and renewal that no other medical practice is billing remote monitoring for the same patient in the same period, and that your practice is not billing multiple monitoring devices in the same month for one patient?
“Billing for remote patient monitoring for the same enrollees as other medical practices: For each medical practice, we determined the percentage of its enrollees who received remote patient monitoring from two or more other medical practices during the year. Billing for multiple devices per enrollee: For each medical practice, we determined the number of times that the practice billed for multiple devices for an enrollee in the same month.” — HHS-OIG Report OEI-02-23-00261, p. 7 (read 2026-10-23)
Does each monthly remote-monitoring record retain the connected device’s transmission log alongside a dated clinician or clinical-staff note showing how those transmitted readings were used to manage the patient’s treatment?
“Remote patient monitoring allows a patient to collect their own health data (e.g., their blood pressure or weight) using a connected medical device that automatically transmits these data to their provider. The provider then uses these data to treat or manage the patient’s condition. ... Treatment management: For each medical practice, we determined the percentage of its enrollees for whom it billed remote patient monitoring who never received treatment management from any medical practice during the year.” — HHS-OIG Report OEI-02-23-00261, pp. 1, 6 (read 2026-10-23)
For every patient billed under chronic care management, does the medical record name two or more chronic conditions expected to last at least 12 months (or until the patient’s death) that place the patient at significant risk of death, acute exacerbation or decompensation, or functional decline?
“Chronic care management (CCM) is care coordination that occurs outside of a regular office visit for patients with two or more chronic conditions that: (1) are expected to last at least 12 months or until the patient dies, and (2) place the patient at significant risk of death, acute exacerbation or decompensation, or functional decline.” — HHS-OIG Work Plan OAS-26-09-007 (read 2026-10-23)
Before the first chronic care management claim is submitted for a patient, does the chart contain written or verbal consent documenting that the patient was told about service availability, possible cost-sharing, that only 1 practitioner can furnish and bill chronic care management in a calendar month, and the right to stop at any time?
“Get the patient’s written or verbal consent for CCM services before you bill for them. ... Inform the patient of these items and document in their medical record: The availability of CCM services; Their possible cost-sharing responsibilities; That only 1 practitioner can provide and bill CCM services during a calendar month; Their right to stop CCM services at any time (effective at the end of the calendar month); That you explained the required information and whether the patient accepted or declined services.” — CMS MLN909188, p. 6 (read 2026-10-23)
When an evaluation and management visit is billed on the same day as a minor procedure (0-day or 10-day global period), does the chart document a significant, separately identifiable evaluation and management service above and beyond the usual preoperative and postoperative work of the procedure?
“In general, E&M services performed on the same date of service as a minor surgical procedure are included in the payment for the procedure. The decision to perform a minor surgical procedure is included in the payment for the minor surgical procedure and shall not be reported separately as an E&M service. However, a significant and separately identifiable E&M service unrelated to the decision to perform the minor surgical procedure is separately reportable with modifier 25.” — CMS Medicare NCCI Policy Manual 2026, Ch. I, §D, p. I-13; see also HHS-OIG Work Plan OAS-26-04-028 (read 2026-10-23)
Does your billing workflow apply the exact same separate-identifiability rules to new patients as to established patients — never billing a separate same-day evaluation and management visit alongside a minor procedure solely because the patient is new to the practitioner?
“If a minor surgical procedure is performed on a new patient, the same rules for reporting E&M services apply. The fact that the patient is ‘new’ to the provider/supplier is not sufficient alone to justify reporting an E&M service on the same date of service as a minor surgical procedure.” — CMS Medicare NCCI Policy Manual 2026, Ch. I, §D, p. I-13 (read 2026-10-23)
Does the practice have a written process to report and return any identified Medicare overpayment within 60 days after identification — or to log a timely, good-faith investigation of related overpayments that suspends the repayment deadline for up to 180 days from initial identification?
“Except as provided in paragraphs (b)(2) and (3) of this section, a person who has received an overpayment must report and return the overpayment by the later of either of the following: (i) The date which is 60 days after the date on which the overpayment was identified. ... [or] (B) The date that is 180 days after the date on which the initial identified overpayment was identified.” — 42 CFR 401.305(b)(1), (3)(ii) (read 2026-10-23)
Select Yes or No / Not sure on the 8 questions above to filter this list to the documentation items your practice needs to address.
time-audit.mjs)Checks anonymous timestamp intervals for overlapping minutes across concurrent care-management / remote-monitoring categories and end-of-month claim-date batching (CMS MLN909188; HHS-OIG OAS-26-09-007). Runs in browser memory with an identifier tripwire and zero procedure code numbers.
This is an outline of the regulatory elements and quoted rules — not a fill-in letter. Every suspension notice cites specific reasons or claim samples that require record-specific responses.
“If prior notice of the suspension of payment, offset, or recoupment is given under § 405.372 or § 405.373, the Medicare contractor must give the provider or supplier an opportunity, before the suspension, offset, or recoupment takes effect, to submit any statement (to include any pertinent information) as to why it should not be put into effect on the date specified in the notice. ... If, under the provisions of paragraphs (a)(2) through (a)(4) of this section, a suspension of payment is put into effect without prior notice to the provider or supplier, the Medicare contractor must, once the suspension is in effect, give the provider or supplier an opportunity to submit a rebuttal statement as to why the suspension should be removed.”
State the date on the notice letter, the NPI(s)/PTAN(s) and claim lines or service dates named, whether the notice cites reliable information of an overpayment (§ 405.371(a)(1)) or a credible allegation of fraud (§ 405.371(a)(2)), and confirm the exact submission deadline printed on the notice.
“CMS, the intermediary, or carrier must within 15 days, from the date the statement is received, consider the statement (including any pertinent evidence submitted), together with any other material bearing upon the case, and determine whether the facts justify the suspension, offset, or recoupment or, if already initiated, justify the termination of the suspension, offset, or recoupment. ... The notice must ... (2) In the case of suspension of payment, contain specific findings on the conditions upon which the suspension is initiated, continued, or removed and an explanatory statement of the determination.”
Respond fact-by-fact to the specific findings or claim samples cited in the notice (for example: signed orders, prior-visit dates, patient consent entries, device transmission logs, or separately identifiable visit notes), and request specific written findings under § 405.375(b)(2).
“Medicare payments to providers and suppliers ... may be ... Suspended, in whole or in part, by CMS or a Medicare contractor ... CMS may find that good cause exists not to suspend payments or not to continue to suspend payments to an individual or entity against which there are credible allegations of fraud if— ... (ii) It is determined that beneficiary access to items or services would be so jeopardized by a payment suspension in whole or part as to cause a danger to life or health; (iii) It is determined that other available remedies implemented by CMS or a Medicare contractor more effectively or quickly protect Medicare funds than would implementing a payment suspension; or (iv) CMS determines that a payment suspension or a continuation of a payment suspension is not in the best interests of the Medicare program.”
Because § 405.371(a) authorizes suspension “in whole or in part,” ask CMS and the contractor to narrow any suspension to the specific service lines or practitioners under review rather than freezing unrelated care, and present any applicable good-cause facts under § 405.371(b)(1)(ii)–(iv) (such as patient access impact in the community or narrower protective remedies).
“Except as provided in paragraphs (d)(2) and (d)(3) of this section, a suspension of payment is limited to 180 days, starting with the date the suspension begins. ... Every 180 days after the initiation of a suspension of payments based on credible allegations of fraud, CMS will— (i) Evaluate whether there is good cause to not continue such suspension under this section; and (ii) Request a certification from the OIG or other law enforcement agency that the matter continues to be under investigation warranting continuation of the suspension.”
Record the delivery proof (date CMS or the contractor received the rebuttal) so the 15-day determination window under § 405.375(a) and the 180-day duration/review clocks under § 405.372(d) and § 405.371(b)(2) are documented from day one.