HHS Issues Proposed Rule

Changes to Physician Medicare Enrollment Process Aimed at Preventing Fraud, Abuse

September 27, 2010 03:40 pm News Staff

At first glance, it may appear that an HHS proposed rule published in the Sept. 23 issue of the (www.gpo.gov)Federal Register imposes an application fee on the treatment of Medicare patients. However, a closer look indicates that the fee may be limited to types of health care suppliers other than physicians.

According to wording in the proposed rule, the proposed changes to Medicare, Medicaid and the Children's Health Insurance Program, or CHIP, should "enhance the provider and supplier enrollment process to improve the integrity of the programs to reduce fraud, waste and abuse in the programs."

If approved, the proposed rule would implement provisions contained in the recently enacted Patient Protection and Affordable Care Act, including those that deal with

  • procedures under which screening is conducted for health care providers and suppliers in Medicare, Medicaid and CHIP;
  • an application fee for certain providers and suppliers;
  • a framework by which temporary moratoria would be imposed under certain circumstances to combat fraud, waste and abuse;
  • guidance for states regarding the standing of health care providers enrolled in one of the three programs but terminated by another; and
  • requirements for suspension of payments to health care providers and suppliers pending credible allegations of fraud in the Medicare and Medicaid programs.

According to Robert Bennett, the AAFP's federal regulatory manager, the proposal to charge an enrollment fee appears to be limited to hospitals; facilities; and suppliers of durable medical equipment, prosthetics, orthotics and supplies, or DMEPOS.

"At first glance, it appears that physicians in general are not subject to the $500 application fee unless they also supply DMEPOS," said Bennett.

The AAFP is reviewing the proposed rule and will submit official comments on the rule to HHS before the department's deadline of Nov. 16 at 5 p.m. EST.

Family physicians are encouraged to offer HHS their personal comments on the rule; directions for submission of comments are available on page 58204 of the Federal Register announcement.