New Medicare and Medicaid Enrollment Rules Take Effect Today

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.

Other key changes include enrollment application fees, the ability to implement temporary enrollment moratoria, and the authorization to suspend payments during an investigation of a “credible allegation of fraud” — one from a reliable source with an “indicia of reliability.”

To learn more about the new regulations, read my article Increased Scrutiny to Obtain and Maintain Medicare and Medicaid Enrollment – Final Regulations Published in the Ober Payment Matters publication.