Presumption When Advance Determination was Requested

150.5.2.5 - Presumption When Advance Determination was Requested (Rev. 1587, Issued: 09-05-08, Effective: 03-03-08, Implementation: 03-01-09) In determining whether the supplier knew, or could reasonably have been expected to know, before furnishing the item, that Medicare would deny payment in advance under §1834(a)(15) of the Act, presume that the supplier knew that Medicare would not pay in all those cases in which a request for advance determination was made, and the contractor denied payment in advance on the basis that the item is not reasonable and necessary under §1862(a)(1) of the Act or that the item is not covered. This is a nonrebuttable presumption.