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CMS Extends Implementation of New ACA-Required Provider Enrollment Changes


March 1, 2016 seems like a long time ago. That is the date that the Federal Register published a proposed rule titled “Medicare, Medicaid and Children’s Health Insurance programs; Program Integrity Enhancements to the Provider Enrollment Process.” If enacted, this proposed rule would implement certain sections of the Affordable Care Act (ACA) regarding provider and supplier disclosures.

These rules may have a serious impact on the payer enrollment process

Ordinarily, the timeline for publishing a final rule of this type should not exceed 3 years from the date the proposed regulation was published; in other words, March 1, 2019. However, if there are exceptional circumstances, the targeted publication date may be extended with public notice.

There were exceptional circumstances experienced with this proposed rule in its implementing policy and operational issues. These included significant public comments and internal stakeholder feedback.

Therefore, the Centers for Medicare & Medicaid Services (CMS) is extending the implementation date for these new requirements by one year, to March 1, 2020.

ACA Proposed Provider Enrollment Requirements Require Disclosures

The ACA-proposed provider enrollment changes would require that Medicare, Medicaid and Children’s Health Insurance Programs (CHIP) providers and suppliers disclose certain affiliations with other providers and suppliers – both current and previous.

The proposed change would also give CMS the authority to deny or revoke a provider’s or supplier’s Medicare enrollment.

According to CMS, the purposes of the proposed rule are to eliminate certain long-standing loopholes that impact program integrity and to help stop and deter ongoing fraudulent and abusive behavior, including patient harm.

You can read the original 2016 Federal Register rule summary and this most recent extension announcement in the Federal Register of 2/28/2019. Stay tuned in the near future – up to March 1, 2020 – for the implementation announcement for this significant payer enrollment change.

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If you require medical credentialing and payer enrollment needs for your practice or medical facility, please contact 1st Assistant. Our experienced and dedicated specialists will provide all credentialing and enrollment services quickly and will monitor your account for ongoing updates and re-attestations. Heidi Henderson, our company owner and President, is eager to meet you and discuss your payer enrollment needs. Please call us at 512.201.2668 or contact us via the website.

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