Provider Followed Guidance

10.2.7 - Provider Followed Guidance (Rev. 739, Issued: 11-01-05, Effective: 07-24-03, Implementation: 01-19-06) The seventh condition that must be met is that the provider or supplier must have followed the guidance provided by the Medicare contractor or by CMS. The provider or supplier’s act or omission must have been in substantial, but not necessarily complete, accord with the terms of the guidance. Deviation from the guidance, if immaterial, would not necessarily be disqualifying. But even a small deviation from the guidance, if material, could be disqualifying. In general, the greater the specificity of the guidance, the greater must be the provider or supplier’s close adherence to such guidance. In addition, the provider or supplier’s act or omission in following the guidance must be either the same act or omission that is the basis of the penalty or must be the direct, but not necessarily the immediately proximate cause of such act or omission.