As of March 25, 2011 the new CMS provider enrollment rules are enacted.  We covered most of the proposed changes in a previous blog post so we’ll just briefly touch on them here.  The primary objective of these changes is to address and help minimize the incidents of  fraud and abuse in the Medicare program.  The new processes includes additional screening,  the suspension of payments where allegations of fraud exist and the new rules grant the CMS the authority to impose a temporary moratorium on new enrollments for particular types of practices in particular geographic areas. There are also new application fees and procedures included as part of the rules revamp.

The new screening process includes assigning providers and suppliers to one of three risk levels: limited, moderate or high.  The screening process will be more detailed and involved the higher the assigned risk category.

Non-refundable Application fees will be charged when initially enrolling in Medicare, when adding a practice location or when revalidating enrollment information.  The fee for March 25, 2011 until Dec 31, 2100 is $505. There are hardship exceptions and refunds are possible if an application is rejected during screening or a temporary moratorium has been applied.

CMS is given the right to impose a moratorium on the enrollment of new Medicare providers of a particular type in a particular geographic areas and the establishment of new practice locations of those types in said locations.  This moratorium would be in response to a high incident of fraud and abuse allegations.

As a practical matter these procedurally changes are likely to have little effect on the typical provider enrollment process.  Where they do come into play it will make the enrollment process considerably more complicated and involved.

The detailed instructions can be found here