The Centers for Medicare & Medicaid Services (CMS) recently proposed a rule that would establish a new appeals process for providers and suppliers whose applications for enrollment or renewal of enrollment were denied. The process would include the right to appeal to an administrative law judge and the Departmental Appeals Board within the Department of Health and Human Services, and judicial review. In addition, the proposed rule would establish time frames in which Medicare fee-for-service contractors must process all provider and supplier enrollment actions, including approving or denying an enrollment application or revalidation within 180 days and change of information and reassignment requests within 90 days. The proposed rule would implement a provision of the Medicare Prescription Drug, Improvement, and Modernization Act of 2003 (MMA).
Under the proposed rule, the time frame in which a provider or supplier must furnish complete information to a Medicare fee-for-service contractor during the enrollment process would be reduced from 60 to 30 days. Furthermore, the Medicare fee-for-service contractor would reject a Medicare enrollment application if a provider or supplier fails to furnish complete information on the enrollment application within 30 days from the date the contractor requests such information or if the provider or supplier fails to submit all required supporting documents on the enrollment application within 30 days of submitting the application.
Also, the Medicare fee-for-service contractor's authority to revoke billing privileges of providers or suppliers would be expanded to occasions when billed services could not have been furnished by a provider or supplier to a beneficiary. Examples of such occasions include when a beneficiary is deceased, the directing physician or the beneficiary is out of the country, or the equipment necessary for testing is not present when the testing is said to have occurred. After a revocation of billing privileges for this or another enumerated reason, the provider or supplier may not apply for participation again in Medicare for three years.
The proposed rule also would require providers and suppliers to agree to receive Medicare payments by electronic funds transfer at the time of enrollment, revalidation or submission of a change of information request.
The full text of the proposed rule is available online here. CMS has requested comments on these proposals and will consider comments received by 5 p.m. on May 1, 2007. Waller Lansden is soliciting comments on the proposed rule, and we will provide these comments to CMS.
The content of this article is intended to provide a general guide to the subject matter. Specialist advice should be sought about your specific circumstances.
