Internet-Only Manual, Pub. 100-06, Chapter 3, Section 90 (Provider Liability) Revision

Change Request (CR) 9708 provides additional criteria for determining when a contractor shall assume a physician, provider, or supplier should have known about a policy or rule.

Contractors shall assume the provider, physician, or supplier should have known about a policy or rule, if: The policy or rule is in the provider, physician, or supplier manual or in Federal regulations; CMS or a CMS contractor provided general notice to the medical community concerning the policy or rule; CMS, a CMS contractor, or the Office of Inspector General (OIG) gave written notice of the policy or rule to the particular provider/physician/supplier;  The provider, physician, or supplier was previously investigated or audited as a result of not following the policy or rule; The provider, physician, or supplier previously agreed to a Corporate Integrity Agreement as a result of not following the policy or rule; The provider, physician, or supplier was previously informed that its claims had been reviewed/denied as a result of the claims not meeting certain Medicare requirements which are related to the policy or rule; or The provider, physician, or supplier previously received documented training/outreach from CMS or one of its contractors related to the same policy or rule.

Source: https://www.cms.gov/Regulations-and-Guidance/Guidance/Transmittals/Downloads/R275FM.pdf