The Critical Role of Experienced Counsel
Engaging counsel experienced in navigating Medicare enrollment matters is critical to avoid unnecessary delays and business disruptions. Enrollment and appeals contractors must adhere to regulations promulgated by the Centers for Medicare & Medicaid Services (“CMS”), as well as the directives set forth in the Medicare Program Integrity Manual (“MPIM”). Even inadvertent errors can have disastrous effects for suppliers seeking to either initially enroll in the Medicare Program or maintain continuous enrollment.
Medicare Enrollment Regulations: Important 2024 Changes for Healthcare Suppliers
In our previous article, Robust Reporting and Compliance Policies Required for Providers to Maintain Medicare Enrollment, we discussed important regulatory updates. Under the Final Rule, Medicare and Medicaid Programs; CY 2024 Payment Policies Under the Physician Fee Schedule and Other Changes to Part B Payment and Coverage Policies; Medicare Shared Savings Program Requirements; Medicare Advantage; Medicare and Medicaid Provider and Supplier Enrollment Policies; and Basic Health Program (the “Final Rule”), CMS expanded its revocation authority to suppliers that fail to adhere to enrollment standards specific to:
- Independent diagnostic testing facilities (“IDTF”)
- DMEPOS suppliers
- Opioid treatment programs (“OTPs”)
- Home infusion therapy (“HIT”) suppliers
- Medicare diabetes prevention programs (“MDPPs”)
These standards are set forth in §410.33(g), 424.57(c), 424.67(b),(e), 424.68(c),(e), and 424.205(b), (d), respectively.
To reduce the risk of enrollment application processing delays, denials, deactivations, stays of enrollment, or revocations of billing privileges, suppliers must remain vigilant regarding Medicare requirements, as well as changes to their businesses that could impact their enrollment status.
Successful Medicare Enrollment Deactivation Appeals
In some instances, a supplier can face deactivation of enrollment for failure to timely revalidate or failure to respond to requests for information from CMS, typically issued through a Medicare contractor. Deactivations with retroactive effective dates could result in all claims submitted after the effective date being deemed overpayments.
In these cases, it is critical to retain documentation of all outreach to the enrollment contractor and good faith efforts to comply with requests for information. In a recent case, Frier Levitt successfully utilized the CMS rebuttal process to overturn the deactivation of a supplier’s Medicare Part B enrollment by demonstrating that the Medicare contractor did not adhere to the MPIM requirements for verification of the information contained in the supplier’s enrollment record. Without this successful rebuttal, the supplier would have a gap in Medicare enrollment and would have been required to submit a new Form 855B application to reactivate enrollment in the Part B program.
Medicare Billing Privilege Revocations: Defending Healthcare Suppliers
Even compliant Medicare suppliers can be subject to a revocation of their billing privileges when proofs of compliance are not properly submitted to enrollment or appeals contractors. Frier Levitt routinely navigates these processes, often correcting procedural missteps for suppliers.
In recent cases, Frier Levitt persuaded appeals contractors to consider a client’s untimely reconsideration request submissions and corresponding proofs of compliance with supplier-specific enrollment requirements. By meticulously rebutting factual allegations of noncompliance and demonstrating the providers’ good faith efforts to implement appropriate corrective actions to prevent recurrence, the suppliers avoided adverse legal actions, reenrollment bars, and disruption to patient care. In many instances, these victories not only impact a supplier’s prospective participation in the Medicare Program but also prevent retroactive revocation dates with potential recoupments for thousands of claims.
How Frier Levitt Can Help With Medicare Enrollment Issues
Our attorneys regularly counsel providers on a variety of enrollment, termination, and/or audit issues related to state and Federal healthcare programs, including, those affecting providers who dispense DMEPOS.
If you have questions about Medicare enrollments, terminations, or audits, or if you have received a revocation notice from Medicare or Medicaid, contact Frier Levitt to speak with an attorney.
Frier Levitt provides strategic, industry-focused legal counsel tailored to your needs. Contact our team today to learn how we can help you.
