The Medicare enrollment process undergoes annual changes at the Centers for Medicare & Medicaid Services (CMS) to ensure it remains up to date with evolving regulations, policies and health care practices.
A number of changes went into effect on Jan. 1, and several of them will affect home health agencies.
Here’s what home health agencies should know about those changes.
Active enrollment, location changes
Starting this year, CMS will impose stricter reporting requirements for home health agencies and other providers as it pertains to changes in ownership, control and practice locations.
“This could be significant,” Mary Carr, VP for regulatory affairs at the National Association for Home Care & Hospice (NAHC), said during a webinar Wednesday. “CMS is going to require that all providers and suppliers report within 30 days a change in practice location. Prior to this change, home health and hospice agencies had 90 days to report a change in practice location. The definition includes additions and deletions of a practice location, so if you’re an organization that’s doing a lot of changes in your locations, adding locations, deleting locations — you’re going to want to pay attention to this, because you have a much narrower timeframe with which to report.”
These changes, according to CMS, aim to improve transparency and ensure timely notification of significant events that may impact the delivery of services.
If a home health provider changes who owns or controls the agency — or if there are changes in key officials responsible for its operation such as CEOs or managers — the agency must notify Medicare within 30 days.
Revocation of enrollment
CMS is also changing the rules around the revocation of enrollment in the Medicare program for providers, and added more reasons for revoking a provider’s enrollment in the Medicare program.
More specifically, CMS added language for cases related to noncompliance and violations of the False Claims Act (FCA).
“CMS has added this because they maintain that they do not have the authority to revoke a provider’s billing privileges simply because they have a judgment against them under the False Claims Act,” Carr said. “They felt that has very much handicapped them, because they have not been able to go after some individuals who defrauded the program as early as they would have liked to. They are now codified into regulation — very specifically — that if you are a provider that has a judgment against you under the False Claims Act, you could be revoked for that solely.”
CMS also added revocation rules for providers who have outstanding debts referred to the U.S. Department of Treasury.
The wording of the rule, Carr pointed out, has been changed from “has an existing debt” to “failed to repay a debt.” This suggests that revocation may occur not only for providers or suppliers with existing debts, but also for those who have failed to fulfill their repayment obligations within the required timeframe.
Deactivation
CMS has the authority to deactivate the Medicare billing privileges of a provider or supplier if they fail to submit any Medicare claims for a certain duration. This rule emphasizes the importance of maintaining active engagement with the Medicare program by regularly submitting claims for reimbursement.
The previous version of the rule stated that agencies must file claims within 12 months to make sure it stayed in the Medicare program. Now that threshold is 6 months.
This means that if a provider or supplier goes without submitting any Medicare claims for six consecutive calendar months, their billing privileges may be deactivated.
“CMS recognizes that there are legitimate providers that do not bill Medicare even though they are enrolled,” Carr said. “For example, a home health agency that only serves Medicaid patients but has to be enrolled in Medicare because the state requires it. They recognize that. But they also recognize that this is an indicator of fraudulent behavior — when a provider enrolls but never bills. That’s the rationale behind that.”
Carr said NAHC is taking the stance that it hopes CMS does not apply this rule broader than it’s been applied today.
“CMS says if you were not at risk for losing your billing privileges under the 12-month rule, you will not be under the six month rule,” Carr said. “CMS is not intending to try to deactivate more valid providers, they’re trying to catch more fraudulent providers more quickly. It bears watching and we certainly will because the reactivation process is not a simple process.”
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