According to the Centers for Medicare & Medicaid Services (CMS), there are currently more than 60 million Americans who are enrolled as Medicare beneficiaries. This number includes individuals enrolled in “original” Medicare as well as in Medicare Advantage plans with private insurers. In order to be able to serve this large portion of the population, a medical provider must enroll as a Medicare provider and keep that enrollment in good standing. This means the provider must meet all of the requirements set forth by CMS and avoid behaviors that could lead to a revocation of the provider’s Medicare status.
Revocation of Medicare Enrollment
Under §424.535 of the Code of Federal Regulations, there are many different reasons for which a provider could have his or her Medicare enrollment status revoked. They include noncompliance with enrollment requirements, causing harm to patients, being convicted of certain felonies, improper medication prescribing practices, and failing to comply with CMS reporting requirements, among many others.
As a provider, you could also lose your Medicare enrollment status for abusing your billing privileges. Under the law, abuse of billing privileges includes but is not limited to:
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