decisionhealth Newsletters, Part B News - 2008 Issue 7 (July)
CMS seeks tighter enrollment rules for physicians, NPPs
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Article Overview
This article explains CMS proposals in the 2009 Physician Fee Schedule that would tighten Medicare enrollment timing and billing-privilege rules for physicians and other nonphysician practitioners. It is relevant to billing, compliance, and provider enrollment staff who need to understand how the proposed changes could affect payment timing, enrollment status, and sanctions tied to revoked privileges. The discussion focuses on general policy changes and administrative consequences rather than code-specific billing guidance.
Why This Topic Matters
Provider enrollment timing can affect whether Medicare claims are payable for services furnished before approval or around a revocation event. Understanding these proposals helps organizations assess compliance risk and monitor potential payment disruptions.
What You Will Learn
- How CMS proposed to change the Medicare enrollment window for newly enrolled physicians and NPPs.
- How the proposed policy would affect billing around initial enrollment approval and application filing dates.
- How CMS proposed to shorten the billing window tied to revoked privileges.
- What types of administrative penalties CMS proposed for attempts to work around revoked billing privileges.
Who Should Read This
- Physicians
- Nonphysician practitioners
- Provider enrollment staff
- Medical billing staff
- Compliance officers
- Revenue cycle managers
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