The Proposed Expansion of CMS’ Revocation Authority Makes Monthly Exclusion Screening of ALL Employees More Important than Ever!
(November 2, 2021): The Centers for Medicare and Medicaid Services (CMS) is the Federal agency tasked with the overall responsibility of managing the Medicare program. Thus, while the Office of Inspector General (OIG) is the primary agency responsible for protecting the integrity of the Medicare program, CMS and its various contractors serve as the program’s gatekeepers responsible for keeping problematic providers and suppliers from enrolling in the Medicare program in the first place or from remaining enrolled in the Medicare program if they pose a financial or safety risk to the program or its beneficiaries.
I. Overview of CMS’s Existing Revocation Authorities:
One of the principle tools used by CMS to protect the Medicare program from the participation of unscrupulous providers is its regulatory authority to revoke a provider’s Medicare billing privileges. In recent years, CMS’s regulatory authority to deny a provider’s enrollment OR to revoke a participating provider’s billing privileges has been greatly expanded. In addition to expanding the regulatory bases that CMS may rely upon when exercising its revocation authority, the 2019 Final Rule also extended the period that a revoked health care provider can be barred from reenrolling in the Medicare program from THREE YEARS to TEN YEARS. A summary overview of the current expanded list of reasons for revocation is discussed in an article entitled “Home Health Revocation Actions by Medicare are Expanding Around the Country.” 
II. CMS Proposes to Expand its Revocation Authorities to Include the Exclusion of Virtually Anyone Associated with the Provided
- First, CMS proposes to expand the categories of parties within the purview of CMS’s denial and revocation provisions to include excluded administrative or management services personnel who furnish services payable by a Federal health care program, such as a billing specialist, accountant, or human resources specialist.
- Second, CMS also proposes to change the existing language from “other health care personnel” furnishing Medicare Services who must be disclosed “on the enrollment application” to ANY “other health care or administrative or management services personnel furnishing services” regardless of whether they must be disclosed on the enrollment application or not.
- Third, CMS proposes to modify the scope of 42 CFR §424.535(e) so that the language concerning other personnel furnishing Medicare reimbursable services is expanded to include “other health care or administrative or management services personnel furnishing services payable by a federal health care program.”
III. Why Should a Provider Care About these Proposed Changes?
 CMS is a component agency of the U.S. Department of Health and Human Services (HHS).
 On September 10, 2019, CMS published its Final Rule titled “Medicare, Medicaid, and Children’s Health Insurance Programs; Program Integrity Enhancements to the Provider Enrollment Process.”
 See Liles Parker’s article dated September 28, 2020. You may also wish to review w our article titled “42 CFR Sec. 424.535(a) Medicare Revocation Actions — Your Medicare Billing Privileges Can be Revoked for a Host of New Reasons. Are You Facing a Medicare Revocation Action? If so, You Must Act Fast to Preserve Your Appeal Rights.”
 “Medicare Program; CY 2022 Payment Policies Under the Physician Fee Schedule and Other Changes to Part B Payment Policies; Medicare Shared Savings Program Requirements; Provider Enrollment Regulation Updates; Provider and Supplier Prepayment and Post-Payment Medical Review Requirements.” 86 FR 39104 (July 23, 2021).