Revenue Cycle

CMS: New rule will help prevent Medicare fraud, speed up reimbursement

Patient Financial Services Weekly Advisor, April 28, 2006

The Centers for Medicare & Medicaid Services (CMS) issued a new rule last week that will help Medicare pay providers accurately and will also protect Medicare from fraud.

The rule makes Medicare enrollment requirements more consistent so providers can bill Medicare more efficiently.

"By standardizing the information that a healthcare provider or supplier must use in order to bill Medicare, we will be better able to protect the Medicare program and assure providers and suppliers that they will be paid promptly," said Timothy B. Hill, the chief financial officer and director of the Office of Financial Management at CMS.

The regulation requires that providers

  • complete and submit a Medicare enrollment application to participate in the Medicare program
  • report changes in enrollment data for most providers and suppliers within 90 days of the change (and within 30 days for durable medical equipment prosthetics and orthotics suppliers)
  • re-certify the accuracy of their enrollment information every five years
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