Anesthesia Coding Alert

CMS will have greater authority to deny or revoke enrollment.

The trend toward deregulation in some areas can seem like a welcome relief, but don’t be fooled into a false sense of security. This is no time to slack on your compliance protocols.

Case in point: CMS wants to nip corruption in the bud from the get-go, suggests a new policy from the agency.

The Program Integrity Enhancements to the Provider Enrollment Process final rule was published in the Federal Register on Sept. 10 and targets organization owners as well as providers and suppliers. Affiliated owners have previously escaped enforcement and exclusion, but CMS aims to close up that loophole.

“The new rule is intended [to] prevent bad actors from circumventing Medicare requirements by using elaborate, inter-provider relationships, or through name and identity changes,” explain Atlanta-based partner attorneys Jessica Tobin Grozine and Hedy Silver Rubinger with Arnall Golden Gregory LLP in online analysis.

Plus: “CMS will have authority to deny or revoke a provider’s or supplier’s Medicare enrollment in certain specified circumstances. These new enforcement authorities will work hand-in-hand with current change of ownership requirements to give CMS greater authority to deny or revoke enrollment,” warn Grozine and Rubinger.

Highlights of the new rule include:

• Medicare providers and suppliers will now need to list all affiliations with other providers and suppliers on their enrollment applications who are currently in debt and/or are suspended, have their rights revoked, and are excluded from federal healthcare programs.
• CMS extends revocation authority to look beyond a provider’s enrollment location and scrutinize more deeply past abusive and negligent behavior in all areas of Medicare.
• If a provider or supplier misleads or lies on an enrollment application, CMS will prohibit enrollment for up to three years.
• Originally, CMS could block enrollees for only three years, but the rule allows the agency to “now block providers and suppliers who are revoked from re-entering the Medicare program for up to 10 years,” says a fact sheet on the rule.

Restrictions go into effect on Nov. 4, 2019.