HCFA moving quickly on new enrollment forms

GAO voices doubts

Worried the snafu with the presidential election might slow the regulatory review process, the Health Care Financing Administration (HCFA) is putting out the word that it plans to have its new Medicare provider enrollment forms in place by next spring — even if it is not able to publish a final rule officially implementing the new enrollment requirements by then.

HCFA officials say the agency will release three new series 855 provider enrollment forms by April. Under this new process, providers will have to revalidate their enrollment information every three years — but they’ll only need to update information, not submit a new form.

Under enrollment rules, HCFA can deny or revoke Medicare billing privileges if it finds a provider has been sanctioned or debarred; been previously suspended for payment problems; submitted false information; or been convicted of a felony. HCFA’s desire to improve the Medicare provider enrollment process is admirable — but actual progress toward meeting this goal is lacking, finds a recent study by the General Accounting Office (GAO).

Weaknesses in the present system allow "dishonest and unqualified" providers into the Medicare program, claims the GAO. One reason for this is sloppy vetting of applicants by Medicare contractors.

Working with provider groups, HCFA has devised a plan to revamp the enrollment process to make it both more streamlined and add safeguards to better police the process. Changes include periodic re-evaluation of provider enrollment information, expanded criteria for rejecting an application, and reducing the number of contractors responsible for enrolling providers in Medicare in order to better supervise the enrollment procedures.

The bottom line is that the GAO likes the plan, but — despite HCFA’s promises — it is worried that implementation is already behind schedule and could fall even further behind.