Medicare looks to ease physician revocation rules

The proposal is part of the Obama administration's strategy to reduce regulatory burdens on doctors and hospitals.

By Charles Fiegl — Posted Oct. 27, 2011

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Physicians who are kicked out of Medicare because of a clerical or administrative error would be reinstated quickly under a rule change proposed by the Obama administration.

The Centers for Medicare & Medicaid Services acknowledges that the consequences for missing Medicare enrollment deadlines are unnecessarily harsh and can jeopardize access to care for patients, according to an Oct. 18 proposed rule. The Medicare agency has proposed rolling back this policy along with a number of other regulations considered Draconian.

"These rules reflect the [Obama] administration's ongoing commitment to reducing regulatory burdens as much as possible, while maintaining full protections for the doctors and patients in our system," Dept. of Health and Human Services Secretary Kathleen Sebelius said during a briefing on the rule changes.

The American Medical Association and other physician associations support numerous changes to regulations and already have secured several revisions, such as loosened requirements for Medicare's electronic prescribing incentive program.

"The [AMA] supports CMS' effort to identify and omit burdensome regulations," AMA President Peter W. Carmel, MD, said. "While we are still reviewing the proposals, we do appreciate that CMS focused on revising unnecessarily punitive policies regarding Medicare enrollment."

CMS proposed stopping enrollment revocations that occur when a physician or other health professional fails to respond to a revalidation or other enrollment-related information request from the Medicare agency. Revocation often is caused by a clerical mistake or a lost letter, but the penalty is a re-enrollment ban for up to three years.

Instead, CMS proposed deactivating, rather than revoking, Medicare billing privileges when a physician fails to submit enrollment information within a specified time frame. The physician then would need to submit an enrollment application to reactivate his or her enrollment.

The Medicare program also has a rule that requires a physician's enrollment to be deactivated after there is no billing activity for 12 consecutive months. For instance, the rule could affect a pediatrician who wants to remain enrolled in the program but who rarely treats Medicare patients.

CMS proposed to revise the rule so it exempts physicians and nonphysician practitioners who enrolled using the CMS-855I application, which is commonly used by physicians, from deactivation due to inactivity. About 12,000 physicians and other health professionals may be affected annually by this change, CMS said.

Other proposed changes to government regulations included rolling back a mandate that all hospitals have a director for outpatient services. CMS would remove the requirement and allow hospitals to decide if a director is needed, said CMS Administrator Donald M. Berwick, MD. Revisions also would remove outdated technical requirements for e-prescribing so they reflect current standards.

Another proposed change would allow one governing body to oversee multiple hospitals in a health system. Currently, each hospital must have its own governing body.

Taken together, the removal of these regulatory burdens is expected to save health professionals $900 million a year in compliance costs, according to CMS.

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