Implementation of Provider Enrollment Provisions - CMS-6028

The Centers for Medicare & Medicaid Services (CMS) published a final rule with comment period, entitled, “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” (CMS-6028-FC). This rule was published in the February 2, 2011, edition of the Federal Register. This rule finalized provisions related to the:

  • Establishment of provider enrollment screening categories
  • Submission of application fees as part of the provider enrollment process
  • Suspensions of payment based on credible allegations of fraud
  • Authority to impose a temporary moratorium on the enrollment of new Medicare providers and suppliers of a particular type or the establishment of new practice locations of a particular type in a geographic area

These details are provided in new sections 19 through 19.4 of Chapter 15 in the Medicare Program Integrity Manual. The MLN Matters article (PDF, 123 KB) is available for viewing in its entirety.




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