A new CMS transmittal details how contractors will deny enrollment applications for owners, physicians or non-physician practitioners who have Medicare debt.
As
Part B News reported in May,
a proposed rule would allow
denial of enrollment applications for owners, providers or suppliers affiliated with an entity that owes Medicare debt, such as overpayments or other penalties. The regulations stem from providers who have debt, shut down operations then try to enroll as a new business.
Overpayments must be $1,500 or more for the contractor to deny enrollment, regardless of whether the applicant is on a repayment plan or payments are being offset, according to
Transmittal 469, also known as change request 8039, dated May 31. The effective date is Oct. 1.
Contractors don’t have to find out whether overpayments exist in other jurisdictions. But the rule applies to initial enrollments and new owners in a change of ownership only, the transmittal states.
When enrollment is denied, providers will see in the Provider Enrollment, Chain and Ownership System (PECOS) the denial reason “other” with the specification, “existing overpayment,” the transmittal states.
Note that the transmittal is based on a proposed rule, and providers have until June 28 to comment on it.