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Your practice should take steps to ensure its Medicare number is never revoked
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How easy is it to lose your Medicare billing privileges for 2 years? Yes, as one of my clients recently learned.
The physician group that provided various prostheses to patients underwent a durable medical equipment (DME) validation survey. When the surveyor sent an email with many typos, the office manager doubted the authenticity of the surveyor’s assertion he was authorized by Medicare to gather information. The surveyor failed to follow the process Medicare outlines for surveyors.
The group refused to allow the surveyor past the receptionist, and the surveyor asserted he was unable to verify the clinic’s information. When the clinic appealed the loss of its DME number, the hearing officer felt they should have been more proactive in verifying the authenticity of the surveyor and upheld the revocation. That was only the beginning of the clinic’s trouble, however.
Fingerprints needed
Medicare is now requiring fingerprints from owners of many organizations. In this instance, Medicare sent a letter to the clinic demanding fingerprints. While the clinic obtained the requested fingerprints from its current shareholders, Medicare’s data on the owners was outdated. The clinic had submitted new 855 forms when one physician went part-time and surrendered his shares as well as when another physician retired. Because the enrollment information was outdated, Medicare concluded the clinic had not met the fingerprint requirement for all owners and notified the clinic its Medicare number would be revoked for 2 years if it did not submit a corrective action plan within 30 days.
When the clinic received the letter, the addressee was on vacation and whoever opened it did not realize its significance. The clinic contacted me the 29th day after the date of the letter. They were sending in new 855 forms and figured that would solve the problem. The letter from Medicare also indicated the clinic can seek reconsideration of the decision within 60 days, so the clinic figured it had plenty of time.
What the clinic did not realize is when CMS reconsiders a decision, only one question is relevant: Was the clinic in violation of the rules at the time of the initial decision? As the clinic had not updated the 855 forms, it was technically in violation.
There was an easy cure, of course, but such a remedy required a valid corrective action plan. Despite that this was a minor recordkeeping error, the odds of prevailing in a reconsideration request are low. Unless the corrective action plan was submitted and accepted, this clinic was almost certain to lose its ability to bill Medicare for 2 years.
Lessons learned
There are many lessons in this story. First, because it was so close to the time limit for submitting the plan, it was vital to know exactly when the letter was received. But the clinic hadn’t kept the envelope nor had it used a “received” stamp on its incoming mail. Envelopes are evidence, not trash.
Second, when someone is on vacation or otherwise unavailable, correspondence from the government cannot await their return. Similarly, whenever someone joins, leaves, changes their ownership status within the practice or gets disciplined by a licensing body or Medicare, consider whether it is necessary to submit an updated 855 Medicare enrollment form. Many things trigger the duty to submit an 855 and it is important to know them. If you don’t know what an 855 form is, ask someone to explain how these Medicare enrollment materials work.
Finally, while I always hope someone will call me to help solve a problem, no lawyer enjoys getting a call on the day a response is due. People often hesitate to call for fear of the cost. That is horribly ironic. This minor recordkeeping error could have been fixed with little effort and almost no legal expense had it been handled promptly. The delay added both expense and peril to the situation.
This clinic went to the precipice of disaster with a few completely understandable errors. With care, you can avoid a similar fate.
- For more information:
- David M. Glaser, JD, can be reached at Fredrikson & Byron, P.A., 200 South Sixth St., Suite 4000, Minneapolis, MN 55402; email: dglaser@fredlaw.com.
Disclosure: Glaser reports no relevant financial disclosures.