Medicare Provider Enrollment: Strategies for Denials, Revocations and Appeals
Challenging Adverse Enrollment Determinations and Ensuring Billing Privileges Amid Expanded CMS Authority
Recording of a 90-minute CLE webinar with Q&A
This CLE course will provide guidance to healthcare counsel on appealing Medicare enrollment denials and revocations. The panel will dicuss the impact of the CMS final rule that expanded its authority to revoke billing privileges and what healthcare providers and suppliers should do in light of the final rule.
Outline
- New CMS rule—expanded authority
- How CMS is using the provision against providers and suppliers
- Strategies for appealing determinations
- Requests for reconsideration
- Corrective action plans
- Agency appeals
- Court appeals
Benefits
The panel will review these and other key issues:
- How has the final rule impacted how CMS is approaching and treating enrollment applications?
- 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?
Faculty
Jessica L. Gustafson
Founding Shareholder
The Health Law Partners
Ms. Gustafson practices in all areas of health care law and devotes a substantial portion of her practice to... | Read More
Ms. Gustafson practices in all areas of health care law and devotes a substantial portion of her practice to representing providers in the Recovery Audit Contractor (“RAC”) and Medicare audit appeals process. She also regularly assists clients with compliance and reimbursement matters. She co-authored an article on the Final Rule for the ABA. She currently serves as the Vice-Chair of the Physician Issues Interest Group for the ABA Health Law Section.
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Andrew B. Wachler
Managing Partner
Wachler & Associates
Mr. Wachler has been practicing health care law for over 30 years. He counsels healthcare providers and organizations... | Read More
Mr. Wachler has been practicing health care law for over 30 years. He counsels healthcare providers and organizations nationwide in a variety of health care legal matters. In addition, he writes and speaks nationally to professional organizations and other entities on health care law topics such as RAC and Medicare and 3rd party payor appeals, Stark, fraud and abuse, compliance and HIPAA.
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Donald H. Romano
Special Counsel
Foley & Lardner
Mr. Romano has extensive experience counseling hospitals, skilled nursing facilities and academic medical centers and... | Read More
Mr. Romano has extensive experience counseling hospitals, skilled nursing facilities and academic medical centers and health systems on compliance, reimbursement and litigation issues involving the complex array of federal regulations governing relationships with physicians. He counsels clients on payment issues relating to the Medicare and Medicaid programs, and regulatory compliance matters, particularly those pertaining to the Anti-Kickback Statute, the physician self-referral statute (Stark Law), HIPAA, and the Medicare enrollment regulations. He previously was a partner in another D.C. based law firm, and prior to that he had over 25 years of experience in the Department of Health and Services, including as a senior attorney in the Office of General Counsel.
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