CMS Publishes Final Rules Regarding Conditions of Participation for Certain Hospitals, Appeals Process for Enrollment Denials, and Extended Repayment Schedules for Overpayments by CMS

June 27, 2008

The Centers for Medicare and Medicaid Services (“CMS”) published several final rules in today’s Federal Register publication that may be of interest to our health care clients.

First, CMS published a final rule related to conditions of participation for hospitals that transfuse blood and blood components. All hospitals that transfuse blood and blood components must meet these new conditions of participation in order to participate in the Medicare program. The final rule is set forth at 73 FR 36469 et. seq.

Second, CMS published a final rule that sets forth the appeals process and the timing for appeals for all suppliers and providers in case of such provider’s or supplier’s enrollment or re-enrollment in the Medicare program or revalidation of an application for Medicare billing being denied and billing privileges being revoked. This final rule sets forth the process for appeal and the timing for filing initial appeals, reconsideration, and for administrative review. It is important for clients to understand this process in case their enrollment or re-enrollment in Medicare is denied or the revalidation of their application is denied. The final rule is set forth at 73 FR 36448 et. seq.

Finally, CMS published a final rule regarding the definition of hardship in regard to repaying overpayments from CMS to providers or suppliers. This may apply to clients that have received overpayments and are on extended repayment schedules or that may qualify for extended repayment schedules under the new definition of hardship. The final rule is set forth at 73 FR 36443 et. seq.

Helping our clients navigate the regulatory landscape is one of the services provided by the McGuireWoods Health Care Practice. For more information about our work for clients, please visit our website.