CMS releases new enrollment policies for providers

March 11, 2011 — The Centers for Medicare and Medicaid Services (CMS) recently released a final rule that outlines changes to Medicare’s enrollment and revalidation policies.

The new screening policies were developed in an effort to reduce fraud and abuse and will be applicable to newly enrolling providers and providers who revalidate their enrollment information beginning on March 25, 2011.

The final rule establishes levels of risk to different provider and supplier types. Based on the assigned level of risk, the provider will be subject to different enrollment policies. Doctors of chiropractic are considered a “limited risk” to the Medicare system, which is the lowest risk level.

Providers in the limited-risk level will be subject to standard Medicare enrollment policies, including license verifications and database checks to verify basic information such as their Social Security Number, National Provider Identifier, and National Practitioner Data Bank licensure. Providers and suppliers in the high-risk level, such as DME suppliers, are subject to criminal background checks and fingerprinting.

CMS has the authority to change the level of risk assigned to various providers at any time, and ACA will closely monitor any changes.

These new policies also will allow CMS to impose enrollment moratoria if it suspects a heightened risk of fraud, waste or abuse in a particular geographic area or involving a certain provider or supplier type. ACA will also closely monitor CMS’s plans in respect to such enrollment moratoria. To read the final rule, click here.

Source: American Chiropractic Association, www.acatoday.org