New CMS Rule Allows Agency To Bar Providers From Medicare

Under a final rule released earlier this week, long term care providers that consistently submit improper claims could have their Medicare enrollment revoked. The rule states that CMS understands that Medicare has many rules and regulations which may sometimes result in claims being improperly submitted. However, CMS notes that “constant, repeated and systemic claims denials” could show that “a provider is not trying in good faith to understand and follow Medicare rules and should no longer be allowed to participate.”

This is the first time that CMS will have the ability to revoke Medicare certification based solely on repeated improper claims being submitted. CMS identified a number of factors that will be weighed before revocation, including the percentage of claims denied and how long the provider has been enrolled in Medicare. The rule also includes a number of other provisions to expand CMS’ ability to revoke Medicare enrollment. For example, if a manager has been convicted of certain felonies, or if an owner owes money to the Medicare program due to a former venture, the provider could lose Medicare certification.

Click here to access the document from CMS. Please note, it is scheduled to be published later today in the Federal Register and will take effect on February 3, 2015.

Click here to read more.



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