CMS Issues Final Rule Strengthening Medicare Provider Oversight.

Date posted: January 5, 2015

The Centers for Medicare & Medicaid Services (CMS) recently issued a final rule designed to prevent Medicare providers and suppliers with unpaid debt from re-entering Medicare and to remove Medicare providers with abusive billing patterns or practices from the program.

Specifically, the final rule gives CMS the ability to:

  • Deny Medicare enrollment to providers, suppliers and owners affiliated with any entity that has unpaid Medicare debt.  CMS will require applicants to repay the debt or enter into a repayment plan in order to enroll.
  • Revoke Medicare billing privileges if the provider or supplier has a pattern or practice of submitting claims that do not meet Medicare requirements.
  • Deny enrollment or revoke billing privileges of a supplier or provider if a managing employee has been convicted of certain felony offenses.
  • Implement consistent effective dates for billing privileges across certain provider and supplier types. For example, CMS will no longer allow ambulance suppliers to bill for up to a year prior to enrollment in the program.

The final rule takes effect on February 3, 2015.


The Final Rule is available at:

http://www.gpo.gov/fdsys/pkg/FR-2014-12-05/pdf/2014-28505.pdf.

The CMS press release is available at:

http://www.cms.gov/Newsroom/MediaReleaseDatabase/Press-releases/2014-Press-releases-items/2014-12-03.html

The CMS fact sheet is available at:

http://www.cms.gov/Newsroom/MediaReleaseDatabase/Fact-sheets/2014-Fact-sheets-items/2014-12-03.html

Medicare Program; Requirements for the Medicare Incentive Reward Program and Provider Enrollment; Final Rule, 79 Fed. Reg. 234, 72500 (Dec. 5, 2014).

Centers for Medicare & Medicaid Services.  “Fact Sheets: CMS Finalizes New Safeguards to Reduce Medicare Fraud.”  Fact Sheet.  03 Dec. 2014.

Centers for Medicare & Medicaid Services.  “New CMS Rules Enhance Medicare Provider Oversight; Strengthens Beneficiary Protections.”  Press Release.  03 Dec. 2014.

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