- CMS proposed a rule on Thursday that would implement provisions of the ACA giving the agency the authority to deny or ban "questionable" providers and suppliers from Medicare enrollment.
- Medicaid and Children's Health Insurance Program (CHIP) providers and suppliers would also be required to disclose existing and previous relationships with certain other providers and suppliers.
- In addition, the provisions in the rule would address "cases where providers and suppliers avoid paying their Medicare debts by reenrolling as a different entity," the press release stated.
Once finalized, the rule would ban providers and suppliers who fail to report their affiliations with individuals that have Medicare, Medicaid, or CHIP debt; have had or will have payment suspensions under a federal healthcare program; or have been denied or revoked from Medicare, Medicaid, or CHIP.
CMS would have additional authority needed to deny or revoke providers' and suppliers' Medicare enrollment if they are revoked under a different name, numerical identifier, or business identity.
It would also allow the agency to revoke physicians' Medicare enrollment if it determines that they have an "abusive" pattern of ordering, certifying, referring, or prescribing Part A or B services, items, or drugs; represent a threat to beneficiaries; or fail to meet requirements. The maximum reenrollment bar would be increased from three to 10 years.
Under the rule, physicians would have to have an approved status in their Medicare enrollment or have validly opted-out to be able to order, certify, refer or prescribe any Part A or B service, item or drug.
CMS says providers and suppliers would have to pay more than $900 million during the first three years to comply with the proposed rule, Modern Healthcare reports.
"We believe that our proposals would help make certain that entities and individuals who pose risks to the Medicare program are removed from and kept out of Medicare for extended periods of time," the proposed rule states.
"In particular, the rule would crack down on providers and suppliers who attempt to circumvent Medicare requirements through name and identity changes as well as through elaborate, inter-provider relationships."
The proposed rule is scheduled to be published online March 1. Comments must be submitted by May 1.