Home Health & Hospice Week

Warning: Ten-year-old judgments could haunt you like the Ghost of Christmas Past.

Sweeping Medicare enrollment changes included in the physician fee schedule final rule could easily impact you, so forewarned is forearmed.

The new and updated authorities include:

• Non-Compliance Revocation Grounds: Permits revocation if the provider is determined to not be in compliance with the enrollment requirements, or in the enrollment application applicable to its provider or supplier type. The Centers for Medicare & Medicaid Services emphasizes providers must adhere to all enrollment requirements, regardless of their placement in title 42.
• False Claims Act Civil Judgments: Revokes enrollment if the provider or any owner, managing employee or organization, officer, or director, has had a civil judgment under the FCA imposed against them within the previous 10 years. For this revision, “civil judgment” does not include FCA settlement agreements.

Be aware: CMS intends to apply this prospectively only — that is, to FCA judgments occurring on or after the effective date of the final rule.

• Violation of Provider and Supplier Standards: That includes for home infusion therapy (HIT) suppliers.
• Provider Debt: CMS may revoke enrollment if the provider has an existing debt that CMS appropriately refers to the Treasury Department. However, CMS will not pursue those cases when the Medicare debt has been discharged by a bankruptcy court; the administrative appeals process concerning the debt has not been exhausted; or the timeline for filing such an appeal, at the appropriate appeal level, has not expired.

Good to Know: CMS affirmed that it will continue to look at the facts and circumstances of each case with “care and conscientiousness,” according to the rule published in the Nov. 16 Federal Register.

In that way, the agency aims to “ensure fairness to the provider,” the National Association for Home Care & Hospice notes in its rule analysis.

• Effective Date of Revocation: Revocation becomes effective 30 days after CMS or the contractor mails notice of its determination to the provider. Exceptions exist, including the date of a surrendered state license; termination from a federal health care program; and/or a felony conviction of an individual or entity.
• Timeframes for Reversing a Revocation: Reversing a revocation due to adverse activity (sanction, exclusion, felony) by one of the parties (for example, owner, managing employee, authorized or delegated official, supervising physician) is possible if the provider terminates its relationship with that party within 15 days of the revocation notification — and submits proof.

Attention: Enrollment action based upon misdemeanor convictions was not finalized, but CMS stated it will continue to monitor cases involving significant misconduct and may pursue future rulemaking.

“CMS’ decision was based on commenters’ concerns with the proposal,” notes the National Association for Home Care & Hospice in its rule analysis.

Note: The physician final rule fact sheet at www.cms.gov/newsroom/fact-sheets/calendar-year-cy-2024-medicare-physician-fee-schedule-final-rule.