CMS Proposes Changes to Provider and Supplier Enrollment Process - McDermott+Consulting

CMS Proposes Changes to Provider and Supplier Enrollment Process

On February 25, 2016 the Centers for Medicare & Medicaid Services (CMS) released a proposed rule, Program Integrity Enhancements to the Provider Enrollment Process (CMS-6058-P), which addresses changes to the provider and supplier enrollment process. These changes are meant to improve the integrity of the program and enhance the ability of the Agency to more quickly respond to any questionable or improper behavior by providers and suppliers.


This proposed rule implements a provision in the Affordable Care Act (ACA) that requires Medicare, Medicaid and Children Health Insurance Program (CHIP) providers and suppliers to disclose any current or previous direct or indirect affiliation with a provider or supplier that has uncollected debt; has been or is subject to a payment suspension under a federal health care program; has been excluded from Medicare, Medicaid or CHIP; or has had its Medicare, Medicaid or CHIP billing privileges denied or revoked. This provision permits the Secretary to deny enrollment based on affiliations that the Secretary determines pose an undue risk of fraud, waste or abuse.


Other major provisions include allowing CMS to deny or revoke enrollment if it is found that the provider or supplier is revoked under a different name, numerical identifier, business identity, or he/she has been terminated from another public program; increasing Medicare re-enrollment bars; and permitting CMS to require that physicians and eligible professionals who order, certify, refer, or prescribe any Part A or B service, item, or drug must be enrolled in or validly opted-out of Medicare.


Comments are due 60 days after the publication of the proposed rule in the Federal Register.


A fact sheet on the proposed rule is available here.