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CMS Finalizes Changes to Medicare Enrollment Rules

December 10, 2014 | No Comments
Posted by Beth Christian

On December 3, 2014, the Centers for Medicare & Medicaid Services (CMS) issued a final rule concerning provider enrollment or re-enrollment in Medicare.   The final rule will give CMS the ability to deny or revoke the enrollment of entities and individuals that pose a program integrity risk to Medicare, including those that have a managing employee that has been convicted of certain crimes.  In addition, CMS will have the ability to deny Medicare enrollment of providers, suppliers, and owners affiliated with an entity that has unpaid Medicare debt.  Providers and suppliers may have their Medicare enrollment revoked if (i) the provider or supplier demonstrates a “pattern and practice” of submitting claims that fail to meet Medicare requirements or (ii) the provider or supplier submits a claim or claims for services that could not have been furnished to a specific individual on the date of service. CMS is also making the effective date of Medicare enrollment uniform for all provider and supplier types.  Providers and suppliers will only be able to submit claims for services rendered as of the filing date of their enrollment application or the date of first furnishing services at a new practice location, whichever is later.


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