Medicare outlines new enrollment provisions

Wednesday, December 3, 2014

BALTIMORE – CMS has tightened its enrollment guidelines in a final rule issued today.

In February 2011, CMS revised its enrollment policy to increase the integrity of the Medicare program, as required by the Affordable Care Act.

New provider enrollment provisions include:

• Adding the ability to deny the enrollment of providers, suppliers, and owners affiliated with an entity that has unpaid Medicare debt. This will help prevent individuals and entities from being able to incur substantial debt to Medicare, leave the Medicare program and then re-enroll as a new business to avoid repayment of the outstanding Medicare debt.

• Adding the ability to deny the enrollment or revoke the billing privileges of a provider or supplier if a managing employee has been convicted of certain felony offenses. 

• Permitting CMS to revoke billing privileges of providers and suppliers that have a pattern or practice of billing for services that do not meet Medicare requirements.

In August, CMS announced that it would begin implementing fingerprint-based background checks for certain providers in the high-risk category.