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Volume 21.05

It is reported that the U.S. Centers for Medicare & Medicaid Services (“CMS”) and the Centers for Disease Control and Prevention (“CDC”) are jointly involved in the development of changes in Conditions of Participation that would require all staff of Medicare and Medicaid certified health care providers to be vaccinated against COVID-19.

Health care providers are being advised to begin efforts to vaccinate employees to better ensure compliance with the effective date of the proposed change.  According to public sources, CMS has not yet announced an effective date; however, an interim final rule, with comment period, is expected in October.  Some organizations and states have already implemented requirements for employees to be vaccinated or face weekly testing.


Under § 424.535(a)(8)(ii), CMS may revoke a provider’s or supplier’s enrollment if CMS determines that the provider or supplier has a pattern or practice of submitting claims that fail to meet Medicare requirements.  According to CMS, due to recently encountered situations, revisions to the current rule are necessary to increase flexibility to address periods of abusive billing, irrespective of the duration of the abusive billing.

Under the proposed rule, Federal Register :: Medicare Program; CY 2022 Payment Policies Under the Physician Fee Schedule and Other Changes to Part B Payment Policies; Medicare Shared Savings Program Requirements; Provider Enrollment Regulation Updates; Provider and Supplier Prepayment and Post-Payment Medical Review Requirements, instead of looking at claim denials over the period of Medicare enrollment, CMS could use a much smaller period for the determination of a risk of improper payments.  The following factors would be applied for purposes of potential Medicare enrollment revocation:

  • The percentage of submitted claims that were denied during the period under consideration.
  • Whether the provider or supplier has any history of final adverse actions and the nature of any such actions.
  • The type of billing non-compliance and the specific facts surrounding said non-compliance (to the extent this can be determined).
  • Any other information regarding the provider or supplier’s specific circumstances that CMS deems relevant to its determination.


CMS has announced that Medicare enrollment activities will resume in a phased-in approach.  Providers that were scheduled for revalidations during the period of suspension will be receiving revalidation notices in October 2021.  The required submissions will be ninety days from the date of notification.

Providers can check the rescheduled revalidation date at the Medicare Revalidation Tool.

The revalidation due date list will be updated to display an adjusted revalidation due date in addition to the provider or supplier’s original revalidation due date (pre-PHE).  The adjusted revalidation due date will be displayed at least three (3) months in advance of the provider’s or supplier’s adjusted due date.