American Speech-Language-Hearing Association
June 9, 2010

Health Care Reform Legislation: Impact on Medicare Enrollment and Payment

The recently passed health care reform bill, H.R. 3590 (the Patient Protection and Affordable Care Act) includes a number of provisions impacting Medicare enrollment and payment. The following sections will or may directly affect speech-language pathologists (SLPs) and audiologists:

  • Overpayments: SLPs and audiologists must report and return a Medicare or Medicaid overpayment within 60 days of identifying the overpayment or be subject to the False Claims Act and civil monetary penalties. This provision is currently in effect, and overpayments that were identified on or before March 23, 2010 (the effective date of the legislation) must be reported and returned by May 22, 2010.
  • Claim submission: Previously, SLPs and audiologists could submit claims on or before December 31 of the calendar year following the year in which the services were furnished. Now, SLPs and audiologists must submit claims within 12 months for services furnished on or after January 1, 2010.
  • Provider and supplier screening and other enrollment requirements: In what seems to be an attempt to address enrollment fraud, the bill sets forth the following requirements for providers and suppliers participating in Medicare and other federal health care programs:
    • Screening: The Secretary of Health and Human Services must establish screening procedures for providers and suppliers. The screening must include a license check and may also include a criminal background check, fingerprinting, site visits, database checks, and any other appropriate screenings.
    • Provisional period of enhanced oversight: The Secretary must establish procedures to provide for enhanced oversight of new providers and suppliers. For a period of no less than 30 days and no more than one year, new providers and suppliers will be subject to oversight that may include prepayment review and payment caps.
    • New disclosure requirements: By March 23, 2011, enrolling or re-enrolling suppliers and providers will need to disclose current or previous affiliations with any provider or supplier that has uncollected debt, had their payments suspended, has been excluded from participating in a federal health care program, or had their billing privileges revoked.
    • Temporary moratorium on enrollment of new providers: If the Secretary determines it is necessary to prevent fraud or abuse, the Secretary may impose a temporary moratorium on the enrollment of new providers and suppliers.
    • Compliance program: The Secretary will require certain providers to establish a compliance program as a condition of enrollment. The Secretary will determine which providers must comply, establish core elements for the compliance program, and determine a timeline for implementation.

For further information, contact Kate Romanow, ASHA's director of health care regulatory advocacy, at 301-296-5671 or kromanow@asha.org


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