On Dec. 5, 2014, the Centers for Medicare and Medicaid Services (CMS) published a final rule on Medicare requirements for provider enrollment. Generally, the final rule enacts stricter regulations for providers by expanding the list of the reasons for denying Medicare enrollment and revoking billing privileges. This article summarizes the major changes for providers, which are effective today.
The final rule expands the debt-related reasons for which CMS may deny Medicare enrollment for providers. Under previous regulations that remain unchanged, CMS may deny enrollment if the provider, supplier, or an owner of the provider or supplier has an existing Medicare debt. The final rule provides that CMS may also deny enrollment if the provider, supplier, or an owner of the provider or supplier was previously the owner of a provider or supplier that had a Medicare debt when enrollment was voluntary terminated or involuntarily terminated or revoked, if the following criteria are met: (1) the owner left the provider or supplier with the Medicare debt within one year before or after the provider or supplier’s voluntary termination; (2) the Medicare debt has not been fully repaid; and (3) CMS determines that the uncollected debt poses an undue risk of fraud, waste or abuse. An owner is defined as “any individual or entity that has any partnership interest in, or that has 5 percent or more direct or indirect ownership of the provider or supplier.”
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