Providers and suppliers face significant changes in Medicare and Medicaid enrollment with the implementation of regulations responding to aspects of the health care reform legislation designed to enhance enrollment procedures to protect against fraud. The intent of the legislation was to prohibit unqualified individuals and entities from obtaining or maintaining enrollment; however, legitimate providers and suppliers will need to understand the new requirements so that billing privileges are not affected by a failure to comply with the rules. The final regulations, which become effective March 25, 2011, “Medicare, Medicaid, and Children’s Health Insurance Programs: Additional Screening Requirements, Application Fees, Temporary Enrollment Moratoria, Payment Suspensions and Compliance Plans for Providers and Suppliers" [PDF] were published on February 2, 2011. Many of the proposed rules [PDF] were adopted as final with little to no change; however, there were some notable changes.
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