Medicare and Medicaid Enrollment and Revalidation Screening Requirements

Obtaining and Maintaining Enrollment and Billing Privileges Amid Heightened CMS Scrutiny

Recording of a 90-minute CLE webinar with Q&A

Conducted on Thursday, May 10, 2012

Recorded event now available

or call 1-800-926-7926
Program Materials

This CLE webinar will provide counsel to healthcare providers with key steps to successfully obtain and maintain their enrollment and billing privileges under the recently enhanced Medicare and Medicaid enrollment requirements.


The Patient Protection and Affordable Care Act (PPACA) further enhanced the Centers for Medicare and Medicaid Services' (CMS) enforcement authority by creating new requirements and sanctions for providers and suppliers participating in the Medicare and Medicaid programs and codifying existing regulations.

The new risk-based enrollment and revalidation screening procedures, effective last year, continue to raise operational and administrative challenges for providers and increase the risk of deactivation or revocation of Medicare billing privileges or termination from the Medicare and Medicaid programs.

Counsel for healthcare providers must understand how CMS and the states have implemented the more rigorous enrollment standards over the past year in order to advise clients on measures to take to obtain billing privileges, accurately revalidate program enrollment, and avoid compliance pitfalls.

Listen as our authoritative panel of healthcare counsel provides practical measures for complying with the new Medicare and Medicaid enrollment requirements to obtain and maintain enrollment and billing privileges.



  1. Enrollment changes
    1. Provider screenings—risk levels
    2. Other gatekeeping mechanisms
      1. Application fee
      2. Temporary moratoria on enrollment
      3. Surety bonds
      4. Accreditation requirements
  2. Enforcement measures
    1. Payment suspension
    2. Termination of provider participation
  3. Responding to notice of enrollment suspension or termination
  4. Appealing a termination or deactivation decision
  5. Corrective action plans—practical considerations when drafting
  6. Lessons learned over the past year of implementation


The panel will review these and other key questions:

  • How have the federal and state governments rolled out the new Medicare and Medicaid enrollment rules over the past year?
  • What compliance best practices should providers use to increase the likelihood of meeting the new enrollment requirements?
  • What approaches are most effective for responding to a notice of enrollment deactivation, revocation of billing privileges or termination?
  • How can providers appeal an enrollment revocation of billing privileges or termination decision?

Following the speaker presentations, you'll have an opportunity to get answers to your specific questions during the interactive Q&A.


Jesse Berg
Jesse Berg

Gray Plant Mooty

He counsels health care providers on federal and state anti-kickback laws, the Stark physician self-referral law,...  |  Read More

Donna J. Senft
Donna J. Senft

Ober | Kaler

She focuses on health care transactions and regulatory matters. She represents various providers, including hospitals,...  |  Read More

Alan E. Schabes
Alan E. Schabes

Benesch Friedlander Coplan & Aronoff

He focuses his practice on health care law, including the representation of long-term care and...  |  Read More

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