Watch for final rule on sweeping changes to enrollment process.
With so many reimbursement and regulatory changes on hospices’ plates this year, an onerous proposed rule may have slipped under your radar. You’d better place it back on before it’s too late.
The Centers for Medicare & Medicaid Services wants providers to drastically increase items they report when they enroll or reenroll in Medicare, according to a proposed rule published in the March 1 Federal Register. And CMS wants greater authority to revoke provider enrollment in a number of new circumstances.
“If these regulations are finalized as proposed, get ready for a fire storm,” warns Washington, D.C.-based healthcare attorney Elizabeth Hogue.
At the top of the list of items to report are “any current or previous direct or indirect affiliation” with a provider or supplier that has had these “disclosable events”:
(1) uncollected debt;
Why? “This provision permits the Secretary to deny enrollment based on affiliations that the Secretary determines pose an undue risk of fraud, waste or abuse,” CMS says in the rule.
CMS also wants to set a very broad definition of “affiliation.” That definition will be “substantially more than related parties,” warns consulting firm The Health Group in Morgantown, W. Va.
Under the proposed reg, affiliations requiring reporting of disclosable events would be:
These requirements will give CMS “significant sanction authority on the provider and so-called Affiliations,” warns The Health Group. The rule “takes the enrollment process, revalidation of enrollment, and reporting changes to an increased level of priority.”
Reporting affiliates and their disclosable events are the provisions most likely to give providers “heartburn,” Hogue predicts. The changes may mean “that some owners are effectively excluded and some managing employees may be unemployable in the home care industry,” she tells Eli.
CMS has been making enrollment/revalidation more important for a while, Hogue observes.
But “many providers … don’t seem to understand the enhanced significance,” she reports. “We encounter providers who don’t file Forms 855 as required, don’t pay attention to the accuracy of the information they put on the forms, don’t understand the forms or concepts involved, and assign staff who lack appropriate knowledge and experience to complete the forms.”
Take action: “Now is clearly the time to get it right on all counts when it comes to provider enrollment,” Hogue stresses. “Getting it right is likely to include review of forms by legal counsel prior to submission,” she advises.
“All providers need to take notice” of the new regs, The Health Group emphasizes.
Outstanding Debt Will Get You Revoked
Other provisions in the rule include:
Stay tuned: Providers should keep an eye out for the forthcoming final rule to see whether CMS changes provisions in response to commenters’ feedback (see stories, pp. 92 and 94).
Note: See the proposed rule at www.gpo.gov/fdsys/pkg/FR-2016-03-01/pdf/2016-04312.pdf.
(2) a payment suspension under a federal health care program;
(3) exclusion from Medicare, Medicaid or CHIP; or
(4) denial or revocation of its Medicare, Medicaid or CHIP billing privileges.