B. Regional office action
The CMS RO reviews the evidence submitted by the hospital concerning the services in question and requests any necessary additional evidence. Unless the hospital has conceded that the services were furnished in the most accessible hospital, the regional office completes or has the DO complete an CMS-1771A (Emergency Services Accessibility Documentation and Determination) by personal or phone contact with the hospital.
As is the case in determining payment to nonparticipating hospital for emergency services, the CMS RO calls upon the Community Health Service (Public Health Service) regional office for assistance in evaluating the medical necessity of the case, including an accessibility determination if medical factors are involved.
The CMS RO sends the beneficiary a notice of its determination and a copy to the provider. If the services are found to be emergency services, the hospital must desist from further efforts to collect the charges and refund any amounts collected for them.