CMS Issues Regulatory Reform Final Rule

The Centers for Medicare and Medicaid Services (CMS), has published a final rule that identifies regulations the agency has deemed to be unnecessary, obsolete, or excessively burdensome. A January 2011 Executive Order directed each federal agency to establish a plan for ongoing review of regulations. This rule, effective July 16,  is one of several that the Department of Health and Human Services (HHS) is finalizing with regard to regulatory reform. Provisions include: 

  • Revocation of Enrollment and Billing Privileges in the Medicare Program:  After providers have had billing privileges revoked, they are barred from participating in Medicare program from the revocation's effective date to the end of the enrollment bar. In the final rule, CMS eliminated the re-enrollment bar if the revocation is based solely on the provider's failure to respond timely to requests for revalidation of enrollment or other information requests from the agency.
  • Deactivation of Medicare Billing Privileges: A proposed provision regarding deactivation of Medicare billing privileges for providers that have not submitted a Medicare claim for 12 consecutive months was not finalized in the final rule. CMS intends to study this issue further. However, CMS did finalize a new provision that would allow the agency to deactivate, rather than revoke, the Medicare billing privileges of a provider or supplier that fails to furnish complete and accurate information and all supporting documentation within 90 calendar days of receiving notification to submit an application and necessary supporting documentation.