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Rick Hindmand was featured in "CMS Regulations Expand Enrollment Screening Procedures and Authority to Suspend Payment," published by RBMA

CMS Regulations Expand Enrollment Screening Procedures and Authority to Suspend Payment
By: Rick Hindmand

The Centers for Medicare & Medicaid Services (CMS) recently announced a final rule (the “Rule”) adopting three levels (limited, moderate and high) of screening standards for Medicare, Medicaid and Children’s Health Insurance Program (CHIP) providers and suppliers based on the level of risk for fraud. The Rule also establishes procedures for the imposition of moratoria on the enrollment of categories of providers, and establishes procedures for the suspension of Medicare and Medicaid payments, in whole or in part, in cases of “credible allegations of fraud.”

The Rule implements certain provisions of the Patient Protection and Affordable Care Act that expand the tools available to CMS and state Medicaid agencies to combat fraud and require CMS and state Medicaid agencies to more closely monitor enrollment in the Medicare, Medicaid and CHIP programs. In its commentary, CMS characterized the Rule as critically important in transitioning its antifraud approach from “pay and chase” to fraud prevention. The payment suspension regulations are particularly noteworthy, as they provide CMS, contractors and state Medicaid agencies with broad discretion and expanded authority that could have a devastating financial impact on some providers who find themselves in the crosshairs of a fraud investigation.

Health care providers within the “moderate” risk level, and therefore subject to unannounced site visits as well as all screening standards for providers that are within the “limited” risk level, include independent diagnostic testing facilities (IDTFs) and portable x-ray suppliers.

To learn more about this Rule, visit: http://www.mcdonaldhopkins.com/alerts/alert.aspx?id=oTMGQUzcNkCem80Nj70BJA.

Reprinted with permission from RBMA RadCast May 17, 2011 issue.

http://www.mcdonaldhopkins.com/news.aspx?id=4N9Y8GEBv0em4wvgc4Rhhw