Rule Sets New Enrollment Requirements for Medicare Suppliers

Baltimore

In an effort to curb fraud and abuse, CMS has issued new enrollment requirements for Medicare providers and suppliers.

A final rule issued last month requires that all health care providers and suppliers fill out an enrollment form and periodically update and certify the accuracy of their enrollment information to receive and maintain billing privileges in the Medicare program.

“Basically, this final rule consolidates current regulations found throughout the Code of Federal Regulations and more clearly defines what Medicare expects from providers and suppliers furnishing items or rendering services to the Medicare beneficiaries,” the agency said in the rule, which takes effect June 20.

In one change from the proposed rule, which was published in April 2003, the three-year cycle for revalidation was upped to five years. The agency said it agreed with comments that a longer cycle would reduce the burden on providers.

Some commenters recommended that the agency not perform unannounced site visits to verify enrollment information, but CMS kept this requirement, explaining that they are a “useful tool.” The agency also rejected a request to implement a grandfather process for providers who already have billing numbers.

The rule was published in the April 21 issue of the Federal Register, available at www.gpoaccess.gov/fr.