Medicare Compliance & Reimbursement

Understand how MPFS 2022 proposals may impact future enrollment.

If you’ve been enjoying the Medicare provider enrollment reprieve due to COVID-19 public health emergency (PHE) flexibilities, we’ve got some bad news for you. The feds plan on reinstating some enrollment and revalidation activities next month.

Update: The Centers for Medicare & Medicaid Services (CMS) “will resume some provider enrollment activities that were paused during the COVID-19 public health emergency,” the agency says in a message to providers. That includes revalidation, application fees, and fingerprint-based criminal background checks.

“CMS will be resuming … revalidation activities in a phased approach for existing providers and suppliers that missed their revalidation due date during the PHE,” CMS explains in a recently issued frequently asked question (FAQ) set on enrollment relief. “Revalidation letters will be sent in October 2021 with due dates in early 2022.”

PHE: However, if you were issued temporary billing privileges during the PHE through your jurisdiction’s Medicare hotline, this latest policy change doesn’t apply to you. Additionally, you should remember that these privileges are provisional and will need to be solidified once the PHE is over, CMS reminds providers and suppliers.

After the PHE ends, you’ll instead be contacted by your Medicare Administrative Contractor (MAC) and prompted to submit a “CMS-855 enrollment application in order to establish full Medicare billing privileges,” FAQ #19 adds. Once your MAC notifies you about submitting an enrollment form, you’ll have 30 days to fulfill the request. If you don’t meet the deadline, your temporary billing privileges will be deactivated, and your Medicare payments will cease, cautions FAQ #16.

Heads up: You may want to reach out to your MAC for a timeline since jurisdictions may approach the update differently.

For example, Part B MAC First Coast Service Operations (FCSO) mentioned that revalidations are still on hold at this time, but that it will issue an alert on its provider enrollment website before restarting, notes the Medicare carrier in a Sept. 13 announcement.

“While the intent of revalidations is to ensure compliance, once revalidations do restart it will be in a phased approach and we will work with you to minimize payment disruptions and deactivations. Upon notification of a restart, we will not act without affording you appropriate time to respond,” expounds FCSO. “We appreciate your patience as we continue to keep processing times at all-time lows.”

Register These MPFS Proposals on Provider Enrollment

As you ease back into the revalidation grind, you might not be thinking about what’s next on the Medicare provider enrollment policy merry-go-round. But you might want to prepare for extra enrollment scrutiny, according to the calendar year (CY) 2022 Medicare Physician Fee Schedule (MPFS) proposed rule.

Reminder: In March 2021, CMS opted to phase in scrutiny of providers’ affiliations during COVID. Under that policy, the agency addressed provisions mentioned in the Program Integrity Enhancements to the Provider Enrollment Process final rule that came out in 2019, which aims to utilize the enrollment process to thwart bad actors, fraud, and abuse (see Medicare Compliance & Reimbursement, Vol. 45, No. 18 and Vol. 46, No. 9)

In the 2022 MPFS proposals, CMS refers to provider enrollment as the “gatekeeper’ that prevents unqualified and potentially fraudulent individuals and entities from being able to enter and inappropriately bill Medicare.” CMS believes that the Medicare enrollment screening process is the best way to cut down on waste, abuse, and fraud in the Medicare programs, so the agency proposes expanding on existing requirements, the rule indicates.

Take a look at two key proposals that CMS wants to change as part of its provider enrollment authority:

Exclusions: CMS wants to expand its denial and revocation provisions for providers and suppliers who employ excluded administrative or management staff to better align with current HHS Office of Inspector General (OIG) guidance. A human resources or a billing specialist could do just as much harm as a clinician or executive, CMS insists.

“For program integrity purposes, the central issue is not the specific individual who engaged in the abusive conduct, but the conduct itself. Accordingly, we believe this regulatory revision is necessary to protect Medicare and its beneficiaries,” the rule says.

Claims: CMS proposes to revise the conditions and definitions surrounding its guidance on claims timelines and non-compliant billing. These proposals are to circumvent providers and suppliers who enroll briefly but quickly rack up the fraud receipts, the rule suggests.

“We propose revisions to focus on the percentage of denials within subsets of the provider’s or supplier’s claim submissions rather than across the entire universe of their claim submissions. Specifically, we would consider the percentage of submitted claims that were denied during the timeframe under consideration,” CMS explains.

Other policies on the MPFS table include DEA certifications, technology updates, and rebuttal rights after deactivation from Medicare provider enrollment.

Resources: Review the CMS FAQs at www.cms.gov/files/document/provider-enrollment-relief-faqs-covid-19.pdf and peruse the fee schedule in the Federal Register at www.govinfo.gov/content/pkg/FR-2021-07-23/pdf/2021-14973.pdf.