Providers’ Billing History May Jeopardize Medicare Status Medicare providers who have a “pattern or practice of submitting claims that fail to meet Medicare requirements” may lose their Medicare billing privileges under final rules that take effect Feb. 3. The Centers for Medicare and Medicaid Services identified five factors that determine if a provider has such a “pattern ... News in Brief
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News in Brief  |   February 01, 2015
Providers’ Billing History May Jeopardize Medicare Status
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Practice Management / News in Brief
News in Brief   |   February 01, 2015
Providers’ Billing History May Jeopardize Medicare Status
The ASHA Leader, February 2015, Vol. 20, 10. doi:10.1044/leader.NIB1.20022015.10
The ASHA Leader, February 2015, Vol. 20, 10. doi:10.1044/leader.NIB1.20022015.10
Medicare providers who have a “pattern or practice of submitting claims that fail to meet Medicare requirements” may lose their Medicare billing privileges under final rules that take effect Feb. 3.
The Centers for Medicare and Medicaid Services identified five factors that determine if a provider has such a “pattern or practice”:
  • Percentage of claims denied.

  • Reasons for the claim denials.

  • History of final adverse actions.

  • How long the billing pattern continues.

  • How long the provider has been enrolled.

Audiologists and speech-language pathologists who provide services to Medicare beneficiaries are required to enroll as Medicare providers and bill Medicare for those services. Medicare legislation clearly states that claims must be submitted for beneficiaries receiving audiology and speech-language services.
To avoid losing Medicare provider status, clinicians should monitor their Medicare enrollment and billing practices to make sure their claims are accurate and review the Medicare revalidation requirements.
The new rules also allow CMS to deny re-enrollment to providers whose enrollment has been (voluntarily or involuntarily) terminated because of outstanding Medicare debt and to deny enrollment or revoke billing privileges for providers with a federal or state felony conviction within the preceding 10 years.
For more information, contact reimbursement@asha.org.
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February 2015
Volume 20, Issue 2