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July 28, 2015

Medicare Reward and Ambulance Payment Rules Await White House Approval

The White House Office of Management and Budget  is the last stop prior to final approval of most agency rule proposals. This week, the Centers for Medicare and Medicaid Services sent to OMB a final rule revising several Medicare provider enrollment conditions, designed to block fraudulent suppliers. The proposal also adjusts an incentive reward for reporting potential fraudulent providers. Initial proposed rules, unveiled in 2013, suggested an increase of the reward from 10 percent of over-payments recovered to 15 percent.

Also, the original draft included a provision limiting the ability of an ambulance service to “back bill” for transportation services provided prior to a new Medicare provider enrollment application. However, ambulance providers commented that back billing is sometimes necessary to provide emergency coverage in a service region following the abrupt withdrawal of another ambulance service, when there isn’t enough time to process a new  application.

The timetable for White House handling of rules and the final components of the new regulations can vary. Approval can be processed within days of receipt or a proposal can linger at OMB for months due to internal discussion and debate.

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