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Don't let this be you: New CMS rule keeps providers out of Medicare

Posted by Margaret Scavotto, JD, CHC on 12/15/14 1:30 PM

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CMS recently published a new rule that makes it easier for CMS to kick providers out of the Medicare program--and harder for providers to get in. 

CMS' new rule:

  • Denies Medicare enrollment to providers/owners who previously owned a provider with unpaid Medicare debt. This will prevent owners who accrue Medicare debt from shutting down their company and re-enrolling as a new corporate entity.
  • Denies/revokes Medicare enrollment to providers if the provider, an owner or a managing employee has a felony offense that "CMS determines is detrimental to the best interests of the Medicare program and its beneficiaries." This includes crimes against persons, financial crimes, and malpractice suits that result in a conviction of criminal neglect or misconduct.
  • Revokes enrollment of providers with a "pattern or practice of submitting claims that fail to meet Medicare requirements."

Don't let it happen to you

While the CMS rule is designed to weed bad actors out of the Medicare program, it can affect providers who inadvertently employ someone with a criminal background, partner with someone with unpaid Medicare debt, or whose billing practices fail to meet Medicare requirements. Your compliance program is your best defense against this enhanced scrutiny and enforcement. Compliance policies and procedures, regular audits, leadership and training can help you:

  • Screen employees for criminal offenses that could get your organization kicked out of Medicare
  • Monitor billing practices to maximize accuracy and integrity and improve processes
  • ...and much more

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