Reminder of new enforcement of Medicare Part B enrollment provisions

NCPA February 12, 2024

Effective in January, CMS made regulatory changes to the Medicare Program Integrity Manual chapter on enrollment in Medicare Part B, which has implications for pharmacists involved in point-of-care testing, mass immunizers, DMEPOS, and diabetes prevention. Namely, CMS defined “authorized official” for who can enroll in Medicare Part B, indirect ownership, and reporting requirements of indirect owners. Other revisions include additional reasons for denial of enrollment (including False Claims Act violations like submitting claims for deceased patients and services not rendered, and standard or condition violations, i.e., non-compliance of any enrollment provision like DMEPOS supplier standards) and new revocation reasons and their effective dates. For details, see a summary of the changes in CMS’ MLN Matters article here, and the redlined changes to the Medicare Program Integrity Manual chapter here.