Medicare Proposes Changes to Enrollment Policy

Baltimore

To weed out unqualified Medicare providers, the Centers for Medicare and Medicaid Services April 25 proposed changes to the provider-enrollment policy. The new policy will be simpler and clearer, according to Tommy Thompson, secretary of the U.S. Department of Health and Human Services.

Under the proposed policy, there would be a different provider-enrollment form for each provider group, instead of one generic form for all providers. CMS would deactivate any suppliers that did not bill Medicare for two consecutive quarters. Currently, CMS deactivates providers that have not billed Medicare for four consecutive quarters.

Other proposed changes include a requirement that Medicare providers re-certify the accuracy of their enrollment information every three years; a requirement that applicants meet all federal, state and local licensure laws; and a provision stating that providers who fail to furnish supporting documentation requested by CMS within 60 days of the request must begin the enrollment process again.

While many of these changes could save Medicare money, they are not likely to affect dramatically the level of fraud and abuse among Medicare providers, according to Lisa Thomas-Payne, president of Albuquerque, N.M.-based Medical Reimbursement Systems. “This is more of a database cleanup initiative,” she said. Instead of making the enrollment process simpler, the new forms actually could increase the paperwork burden for providers that operate in multiple categories, Thomas-Payne added.

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