Important New Concerns for Billing Companies, Providers and Suppliers

June 1, 2015Articles BC Magazine

Victoria Heller Johnson and Edward J. Cyran authored the BC Magazine article, "Important New Concerns for Billing Companies, Providers and Suppliers." Full text can be found in the May/June 2015 issue, but a synopsis is noted below.

On February 3, 2015, the authority of the Centers for Medicare & Medicaid Services (CMS) to deny Medicare enrollment and revoke Medicare billing privileges of providers and suppliers significantly expanded.

The goal of the increased authority over these decisions is to strengthen the integrity of the Medicare program and curtail enrollment of fraudulent providers.

Key changes to Medicare enrollment and revocation of billing privileges include, providers and suppliers can now be held responsible by CMS for overpayments or other Medicare debt, currently and previously held, andCMS can deny enrollment or revoke billing privileges if the provider or supplier has been convicted within the last 10 years for any state or federal felony.

The increased authority also covers a prohibition against back-billing Medicare for ambulance suppliers and the revocation of billing privileges based on a pattern or practice of billing improper claims.

On account of these new regulations, billing companies, coding professionals and providers and suppliers have become areas of focus.