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Final Medicare/Medicaid Enrollment and Screening Requirement Regulations Adopted

March 22, 2011 | 1 Comment
Posted by Beth Christian

In a November 29, 2010 blog post, we reported that the Centers for Medicare and Medicaid services had published proposed regulations which would modify Medicare/Medicaid provider screening and enrollment requirements.  The regulations have now been adopted as final, and will go into effect March 25, 2011. 

Under the final regulations, providers will be placed into one of three screening categories by the Centers for Medicare and Medicaid Services.  The categories were developed based upon an analysis of those provider types that would be most likely to fall within a limited, moderate or high degree of risk for violating the fraud and abuse laws.  Under the final rule, all providers will be subject to periodic revalidation procedures.  CMS anticipates that all providers will be revalidated by the end of 2015, with 20% of providers being re-screened each year beginning in 2011.  The regulations also expand the ability of Medicare and Medicaid to suspend payments to providers in appropriate circumstances.


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