In the enrollment section of the rule, CMS has proposed stronger Medicare enrollment oversight, including additional grounds for denying or revoking enrollment and expanded authority for retroactive revocations. These policies are broad and apply across Medicare providers and suppliers and could affect ASCs that participate in Medicare.
“The proposed rule includes new measures that would help CMS recover more taxpayer dollars from noncompliant providers and suppliers,” according to a CMS release. “Currently, CMS can claw back payments retroactive to the date of noncompliance for certain Medicare provider enrollment revocation grounds. The proposed rule would make this possible for all Medicare provider enrollment revocations, regardless of the revocation reason. This would allow CMS to recoup additional taxpayer funds and help ensure that noncompliant providers and suppliers are not receiving Medicare payments.”
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In addition, CMS has proposed to expand the number of reasons for which the agency can take action against problematic providers. According to the release, these would include, but not be limited to, the following:
- CMS could cancel a provider’s or supplier’s Medicare enrollment if the enrollment presents a high risk of fraud, waste and abuse because the provider/supplier is located within a limited geographic area that has an excessive number of providers and suppliers.
- CMS could deny or revoke a provider’s or supplier’s Medicare enrollment if they have been convicted of a misdemeanor related to sexual assault or financial misconduct within the past 10 years.
Currently, CMS can rescind payments retroactive to the date of noncompliance for certain Medicare provider enrollment revocation grounds. The proposed rule, however, would make this possible for all Medicare provider enrollment revocations, regardless of the revocation reason.
ASCA will comment on the rule by the 5 p.m. EDT, Aug. 31 deadline.
CMS released the CY 2027 Home Health Prospective Payment System proposed rule on July 1; it can be viewed on the Federal Register.