October 16, 2021

Volume XI, Number 289

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CMS Proposes New and Significantly Enhanced Enrollment Requirements

This webinar will provide an in depth review of the proposed rule released by CMS on March 1, 2016, entitled, “Medicare, Medicaid, and Children’s Health Insurance Programs; Program Integrity Enhancements to the Provider Enrollment Process” that, if finalized, would have a significant impact on providers and suppliers operating in the Medicare, Medicaid and CHIP programs. Consistent with CMS’s recent history of utilizing the enrollment rules to combat fraud, waste and abuse through early identification efforts tangential to the enrollment process, this Proposed Rule seeks to expand CMS’s arsenal by adding yet another set of enrollment and revalidation reporting requirements, as well as significant expansions to CMS’s ability to deny and revoke the billing privileges of providers and suppliers.

If enacted, these proposed rules will, in part:

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  • Create new obligations on providers and suppliers to monitor and disclose certain present and past “affiliations” with other providers or suppliers who/that underwent certain “disclosable events”
  • Create new bases for a CMS denial or revocation of a provider’s or supplier’s enrollment
  • Increase the length of re-enrollment bars in the event of a revocation
  • Increase the length of re-application bars in the event of a denial
  • Implement changes to CMS’s enrollment moratoria authority
  • Implement changes to the process for reactivating a deactivated supplier’s billing privileges
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