Medicare providers and suppliers are heavily regulated by the federal government but also rely on it as a significant payor. Through the final rule, “Requirements for Medicare Incentive Reward Program and Provider Enrollment,” the Centers for Medicare & Medicaid Services (CMS) expanded its authority to deny or terminate enrollment for providers and suppliers on program integrity grounds. A revocation under this expanded authority is costly, resource-intensive and time-consuming to correct, and could significantly impact or even destroy a provider or supplier’s business. Providers and suppliers must thus remain well informed regarding regulatory developments and any potential impact on their business.

During the webinar, the speakers will discuss the highlights of the final rule, including sensible new safeguards to minimize past debtors and felons from the Medicare system. However, the focus will be on the challenges that providers and suppliers are currently facing in the post-implementation world. Specifically, the final rule contains a vague “abuse of billing privileges” section that permits the complete revocation of billing privileges if CMS determines that the provider or supplier has a “pattern or practice” of billing for services that do not meet Medicare requirements. The speakers will analyze this new standard and the key challenges that arise from it. The speakers will also discuss the current role of Medicare contractors in claims processing and their role under the new standard.