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The Importance of Regularly Updating Medicare Enrollment Information

The Centers for Medicare & Medicaid Services (“CMS”) Provider Enrollment, Chain and Ownership System (“PECOS”) allows registered users to securely and electronically submit and manage their Medicare enrollment information.   There are a number of functions that can be accomplished through PECOS, including but not limited to updates and changes, revalidations, voluntary withdrawals, and deactivations.   

Beginning in March, CMS exercised its waiver authority to supply COVID-19 Medicare Provider Enrollment Relief, which relaxed certain requirements to accommodate the public health emergency.  Notwithstanding these waivers, providers must still be vigilant to ensure that their CMS enrollment profiles are accurate.   One example of an easily overlooked, but crucial, update is a change of practice composition and/or ownership.  

A recent case handled by our firm is illustrative:

 A physician owner (the “Physician”) of a medical practice (the “Practice”) departed and was no longer affiliated with the Practice in any capacity.  Subsequent to his departure, the Physician was listed as an Excluded Individual on the Department of Health & Human Services’ Office of Inspector General’s List of Excluded Individuals/Entities (“LEIE”). As an Excluded Individual, the Physician was prohibited from participating in federally funded healthcare programs.  The conduct that led to the Physician’s exclusion had nothing to do with the Practice, but because the Practice did not timely update its enrollment profile to reflect the Physician’s departure,  CMS flagged the Practice for employing an Excluded Individual and revoked the Practice’s Medicare billing privileges retroactively to the date of the Physician’s exclusion.  This harsh penalty occurred despite the fact that the Physician had left the Practice many years earlier, and the penalty also invalidated otherwise appropriate medical claims for dates of service following the Physician’s exclusion.  Following a complex appeal process, we successfully achieved a retroactive rescission of the revocation of the Practice’s enrollment status.  As a result, its billing privileges were reactivated, its revenues were restored, and thousands of Medicare beneficiaries were able to continue their care with the Practice.

How Frier Levitt Can Help

This case is an important reminder that inadvertent neglect of seemingly ministerial tasks can have far-reaching consequences.  For more information about Medicare enrollment, reporting, audits, rescissions, revocations, appeals, etc., contact Frier Levitt to speak to an attorney.