RO Notice of Acceptance

2782 - RO Notice of Acceptance (Rev. 1, 05-21-04) The RO transmits a letter of acceptance (Exhibit 165) to the provider and encloses a copy of the completed Form CMS-1561. The RO includes in the letter the following notation: “The (name of intermediary) has been authorized to serve as your fiscal intermediary.” This is the official notice to the provider of its designated intermediary. In all acceptance notices for hospitals, the RO should state that the agreement applies to the entire hospital, or identify the distinct part (including PPS-excluded psychiatric or rehabilitation units covered by the agreement) or portions of the hospital covered and not covered in the case of a general hospital complex. In the case of a new hospital the notice must clearly establish the provider numbers which apply to each part of the institution. If a request to establish a PPS-excluded psychiatric or rehabilitation unit or swing-bed approval is refused, the RO must be sure that the refusal is reflected in the Notice of Acceptance. The provider number (see §2779) must be imprinted on the agreement, or if more than one provider number is assigned, all numbers must be imprinted on the agreement. The RO furnishes the SA and intermediary with a copy of the provider letter. This will assure that the SA and intermediary understand what action has been taken on distinct parts or excluded units.