Help for physicians on Medicare deadlines

Physicians re-enrolling in or reporting changes to Medicare lately understandably might feel that one inadvertent false move could have catastrophic results.

That's because the Centers for Medicare & Medicaid Services has put even stricter rules on how long physicians and others have to report on certain practice-related changes -- with failure to comply possibly resulting in a year or two of banishment from the program.

The idea behind these more stringent rules, a tactic CMS has eyed for a long time, is to stop fraud before it starts. CMS has said specifically that it wants to catch fraud in "high vulnerability" areas such as major cities. It also wants to crack down on fraud in durable medical equipment, prosthetics, orthotics and supplies, referred to as DMEPOS.

But physicians who have nothing to do with fraud and for whom there would be no reason to be under suspicion -- in other words, the vast majority of doctors -- are now paying the price. To catch a few bad apples, CMS is targeting everyone.

Thanks to the 2008 implementation of the National Provider Identifier, many physicians still are dealing with late and underpaid Medicare checks because of glitches in their re-enrollment.

And now, there are these additional new rules when it comes to Medicare re-enrollment. If a physician's practice has changed location, or ownership and control, or if the doctor has had an adverse legal action, then there are only 30 days, down from 90, to tell CMS. Otherwise, the physician risks losing billing privileges for a year, possibly up to two years, after a Medicare contractor finds out a change has occurred.

Also, physicians previously were able to bill retroactively for services provided up to 27 months before filing Medicare enrollment. Now they can only bill retroactively for services provided up to 30 days prior to the filing effective date.

If a physician does everything right on his or her applications, but a Medicare contractor or someone or something outside the physician's practice causes a problem -- that's just tough luck. There's no allowance for that in the rules.

The American Medical Association has been aggressive in telling CMS about the concerns from physicians for such a wide-ranging approach. It has called for more resources for handling enrollment applications, given the delays physicians have had from waiting on Medicare contractors during the NPI re-enrollment.

As it is, the AMA was among those who successfully fought to have enforcement of the new rules delayed from Jan. 1 to April 1 so Medicare could deal with the backlog of claims from physicians still having problems getting their NPI applications settled.

The Association, in cooperation with the Medical Group Management Assn., also has developed an online resource for its members, and MGMA members. It takes physicians step by step through the forms they need, the Internet filing resources available and everything else they require to have the smoothest possible re-enrollment.

The AMA also has been able to cut through the red tape for individual members having problems with NPI and re-enrollment issues. The Association continues to advocate for a more reasonable time for re-enrollment and retroactive Medicare pay.

Medicare fraud is a crime and an unacceptable burden on an already stressed system. But the solution should not entail making life harder for innocent physicians.