CMS Proposes New Appeals Process and Time Frames for Medicare Enrollment.The Centers for Medicare & Medicaid Services (CMS (1) See content management system and color management system. (2) (Conversational Monitor System) Software that provides interactive communications for IBM's VM operating system. ) recently proposed a rule that would establish a new appeals process for providers and suppliers whose applications for enrollment or renewal of enrollment were denied. The process would include the right to appeal to an administrative law judge administrative law judge n. a professional hearing officer who works for the government to preside over hearings and appeals involving governmental agencies. They are generally experienced in the particular subject matter of the agency involved or of several agencies. and the Departmental Appeals Board within the Department of Health and Human Services Noun 1. Department of Health and Human Services - the United States federal department that administers all federal programs dealing with health and welfare; created in 1979 Health and Human Services, HHS , and judicial review. In addition, the proposed rule would establish time frames in which Medicare fee-for-service contractors must process all provider and supplier enrollment actions, including approving or denying an enrollment application or revalidation within 180 days and change of information and reassignment requests within 90 days. The proposed rule would implement a provision of the Medicare Prescription Drug, Improvement, and Modernization Act The Medicare Prescription Drug, Improvement, and Modernization Act (Pub.L. 108-173, 117 Stat. 2066, also called Medicare Modernization Act or MMA) is a law of the United States which was enacted in 2003. of 2003 (MMA (Microcomputer Managers Association, Inc.) A membership organization with chapters throughout the U.S. that was devoted to educating personnel responsible for personal computers. It disbanded in 1996. Mma - A fast Mathematica-like system, in Allegro CL by R. Fateman, 1991. ). Under the proposed rule, the time frame in which a provider or supplier must furnish complete information to a Medicare fee-for-service contractor during the enrollment process would be reduced from 60 to 30 days. Furthermore, the Medicare fee-for-service contractor would reject a Medicare enrollment application if a provider or supplier fails to furnish complete information on the enrollment application within 30 days from the date the contractor requests such information or if the provider or supplier fails to submit all required supporting documents on the enrollment application within 30 days of submitting the application. Also, the Medicare fee-for-service contractor's authority to revoke billing privileges of providers or suppliers would be expanded to occasions when billed services could not have been furnished by a provider or supplier to a beneficiary. Examples of such occasions include when a beneficiary is deceased, the directing physician or the beneficiary is out of the country, or the equipment necessary for testing is not present when the testing is said to have occurred. After a revocation of billing privileges for this or another enumerated This term is often used in law as equivalent to mentioned specifically, designated, or expressly named or granted; as in speaking of enumerated governmental powers, items of property, or articles in a tariff schedule. reason, the provider or supplier may not apply for participation again in Medicare for three years. The proposed rule also would require providers and suppliers to agree to receive Medicare payments by electronic funds transfer See EFT. (application, communications) electronic funds transfer - (EFT, EFTS, - system) Transfer of money initiated through electronic terminal, automated teller machine, computer, telephone, or magnetic tape. at the time of enrollment, revalidation or submission of a change of information request. The full text of the proposed rule is available online here. CMS has requested comments on these proposals and will consider comments received by 5 p.m. on May 1, 2007. Waller Lansden is soliciting comments on the proposed rule, and we will provide these comments to CMS. The content of this article is intended to provide a general guide to the subject matter. Specialist advice should be sought about your specific circumstances. Mr Kevin Kimery Waller Lansden Dortch & Davis Nashville City Center 511 Union Street Nashville TN 37219 1790 UNITED STATES United States, officially United States of America, republic (2005 est. pop. 295,734,000), 3,539,227 sq mi (9,166,598 sq km), North America. The United States is the world's third largest country in population and the fourth largest country in area. E-mail: info@wallerlaw.com URL URL in full Uniform Resource Locator Address of a resource on the Internet. The resource can be any type of file stored on a server, such as a Web page, a text file, a graphics file, or an application program. : www.wallerlaw.com Click Here for related articles (c) Mondaq Ltd, 2007 - Tel. +44 (0)20 8544 8300 - http://www.mondaq.com |
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