Medicare Incentive Reward Program and Provider Enrollment Final Rule

On December 5, 2014, the Centers for Medicare and Medicaid Services (“CMS”) published the Requirements for the Medicare Incentive Reward Program and Provider Enrollment Final Rule. This final rule makes policy changes to various provider enrollment requirements, which include: expanding the instances in which a felony conviction can serve as a basis for denial or revocation of a provider or supplier's enrollment; if certain criteria are met, enabling CMS to deny enrollment if the enrolling provider or supplier had an ownership relationship with a previously enrolled provider or supplier that had a Medicare debt; enabling CMS to revoke Medicare billing privileges if it determines that the provider or supplier has a pattern or practice of submitting claims that fail to meet Medicare requirements; and limiting the ability of ambulance suppliers to “back bill” for services performed prior to enrollment.

The provisions of this rule take effect on February 3, 2015. The Final Rule is published on the Federal Register and is available here.