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Be careful who you do business with. Proposed CMS enrollment rule requires affiliate disclosure

Posted on 10/08/19

Earlier this month, the Centers for Medicare & Medicare Services (CMS) published a final rule designed to increase their ability to identify unscrupulous organizations and individuals associated with prior fraud, waste, and abuse in the system.

The proposed enrollment rule would mandate that CMS “research and analyze” provider and supplier affiliates, giving CMS authority to deny or revoke enrollment if a provider has had a prior relationship with a banned organization, even if the provider itself has not been targeted with a federal investigation. Patterns of behavior that are abusive or representing a threat to the health and safety of Medicare beneficiaries will be scrutinized, as will outstanding debt or unpaid taxes, and state license revocation.

The regulation, known as the Program Integrity Enhancements to the Provider Enrollment Process, takes effect on November 4, 2019. Comments on the rule are being accepted until 5:00  pm on November 4 via regulations.gov.

CMS claims this new rule will save the government $47.4 billion over the next 10 years.

If you’re a healthcare provider and need credentialing and revalidation support, KB Healthcare Consulting can help with all payers, not just CMS. For more information, contact Johna Kennedy-Preston as 941-365-4617 or .

About the Author

Johna Kennedy- Preston

Kerkering, Barberio & Co.
1990 Main St., Suite 801
Sarasota, FL 34236
(941) 365-4617

Ms. Kennedy-Preston is a senior-level healthcare business operations consultant. She provides clients with expertise in revenue cycle management, coding education, managed care contracting, mergers and start-up ventures, Medicare recoupment and reporting issues, credentialing with insurance carriers and assistance with state and federal licensing. 

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