Maria Samantha Quinain, PT, and Stay Fit Physical Therapy & Core Wellness, Inc., DAB CR5638 (2020)

DECISION

I sustain the determination of a Medicare contractor to approve the reassignment of Medicare billing privileges (referred to in Medicare terminology as a “reassignment of benefits”) from Maria Samantha Quinain, PT, Petitioner, to Stay Fit Physical Therapy & Core Wellness, Inc. (Stay Fit), effective February 20, 2020.  This determination allows Stay Fit to claim reimbursement for services provided by Petitioner on dates beginning January 21, 2020.

I. Background

This case’s caption lists both Petitioner and Stay Fit as Petitioners.  However, only Petitioner has a right to a hearing inasmuch as the initial and reconsidered determinations address only her application to reassign her Medicare billing privileges to Stay Fit.  As a practical matter, however, my decision addresses whether Stay Fit may claim reimbursement for Medicare services performed by Petitioner on dates prior to January 21, 2020.

The Centers for Medicare & Medicaid Services (CMS) filed a prehearing exchange that includes a brief and six proposed exhibits, identified as CMS Exhibit (Ex.) 1-CMS Ex. 6.

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Simultaneously, CMS moved for summary judgment, asserting that there are no issues of disputed material fact.  I gave Petitioner until July 9, 2020 to reply to CMS’s exchange and motion.  She filed a reply on June 12, 2020 (P. Reply), and confirmed that this is her final statement.  She also provided me with an exhibit that she did not identify.  I identify this exhibit as P. Ex. 1.  I receive the parties’ exhibits into the record.

It is unnecessary that I decide whether the criteria for summary judgment have been met here inasmuch as neither CMS nor Petitioner provided me with the testimony of a witness.  The case is ripe for decision based on the parties’ written pre-hearing exchanges.

II.  Issue, Findings of Fact and Conclusions of Law

A. Issue

The issue is whether a Medicare contractor correctly determined that the effective date of reassignment of Medicare billing privileges from Petitioner to Stay Fit is February 20, 2020.

B. Findings of Fact and Conclusions of Law

On February 20, 2020, Petitioner filed an application with the contractor to reassign to Stay Fit her Medicare billing privileges.  CMS Exs. 1, 2.  She filed this application because she had become employed by Stay Fit as a physical therapist.  P. Ex. 1.  The contractor found this application to be acceptable, and processed it.  On March 2, 2020, the contractor approved the application, granting Petitioner an effective date for reassignment of February 20, 2020, the date that she filed her application.  CMS Ex. 3 at 1.  That approval enabled Stay Fit to retroactively request reimbursement for services provided by Petitioner as early as January 21, 2020.  Id.

Regulations govern the determination of an effective date for Medicare participation or for the reassignment of the authority to claim reimbursement for services.  Generally speaking, the earliest effective date that a contractor may grant is the date when the applicant files an application that the contractor determines to be acceptable.  42 C.F.R. § 424.520(d)(1).  The earliest effective date of reassignment that the contractor could have granted to Petitioner is February 20, 2020, because that is the date Petitioner filed an application that the contractor determined to be acceptable.  Consequently, the contractor’s determination is entirely consistent with the regulation.  Gaurav Lakhanpal, MD, DAB No. 2951 (2019).

As I have noted, the contractor allowed Stay Fit to claim reimbursement for services provided by Petitioner as early as January 21, 2020.  That is authorized by another

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regulation, 42 C.F.R. § 424.521.  I have no authority to direct CMS or the contractor to allow billing for services that Petitioner provided prior to that date.

In her exchange, Petitioner argues that she became employed by Stay Fit on December 10, 2019.  P. Reply.  She contends that Medicare policy allows a non-enrolled physical therapist to treat patients under the direct supervision of an enrolled therapist.  P. Ex. 1.Petitioner contends that this supervisory relationship existed between her and Stay Fit beginning on December 10 and that, consequently, Stay Fit should be permitted to claim reimbursement for services that Petitioner provided while supervised.  P. Reply.

This is an issue that does not fall within the ambit of Petitioner’s hearing request.  In this case, I may only consider whether the contractor correctly assigned an effective reassignment date to Petitioner of February 20, 2020, based on the application that she filed on that date.  I have no authority to consider a different legal question—that being whether Stay Fit might be able to claim reimbursement for services provided by Petitioner, as a supervised employee, on dates prior to January 21, 2020—because that relationship is not an element of the application and approval process that I address here.