By: Anne Branan
The Centers for Medicare and Medicaid Services (“CMS”) published a final rule, effective February 3, 2015, that drastically expanded CMS’s ability to revoke a provider’s Medicare billing privileges (“Final Rule”). This Final Rule has proved to be a serious thread to providers as CMS uses this new authority to strip more providers of their Medicare billing privileges and provider agreements.
Even before the Final Rule, CMS had a long list of reasons it could rely on to revoke a provider’s billing privileges. However, in the past, CMS may have conducted an audit of the suspect claims and given then provider a chance to explain or correct the claims. But now, CMS appears to favor using revocation to rid the Medicare program of providers it considered to be “bad actors.”
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