Significant changes effecting Medicare- and Medicaid-enrolled providers and suppliers take effect today, March 25, 2011. The new regulations are in response to provisions in the recent health care reform legislation designed to enhance the enrollment procedures to protect against fraud. All Medicare-enrolled providers and suppliers were grouped into one of three categories “limited,” “moderate,” or “high” risk, with delineated enrollment screening procedures for each category. The greater the perceived risk of fraud, the more scrutiny for the applicant or enrollee.
Medicare for Geeks is written by Donna J. Senft, an attorney and shareholder in Baker Donelson's Health Law Group. Donna has nearly a decade of experience in advising enrolled providers to maintain complete PECOS data and complete revalidations to avoid deactivation or revocation of billing privileges, and to file CAPs and appeals when privileges are lost. She also helps providers with coding and payment issues, peer review and professional standards, and professional disciplinary matters.
Baker Donelson's Health Law Group dates back nearly 35 years, to the beginnings of health law as a recognized practice area. The Group is a leader in providing premier legal services to academic and community hospitals, health systems, long-term care facilities, clinical laboratories, institutional pharmacies, physicians and physician organizations.