The Centers for Medicare and Medicaid Service (CMS) reminds the providers on Final Adverse Action need to be reported on time.

Who should report final adverse action(s)?

• Medicare providers or suppliers with new or unreported Final Adverse Action(s).
• Those individuals listed on an application as having managing control or an ownership interest.

What should be reported?

CMS NO LONGER requires Medicare Payment Suspensions and CMS-Imposed Medicare Revocations to be reported. The updated list of reportable Final Adverse:

• Felony and Misdemeanor conviction(s) within 10 years
• Current or Past Suspension(s)/Revocation(s) of a medical license
• Current or Past Suspension(s) Revocation(s) of an accreditation
• Current or Past Suspension(s) or Exclusion(s) imposed by the U.S. Department of Health and Human Service’s Office of Inspector General (OIG)
• Current or Past Debarment(s) from participation in any Federal Executive Branch procurement or non-procurement program
• Medicaid exclusion(s), revocation(s) or termination(s) of any billing number
• Any other Current or Past Federal Sanction(s)

 

When should be reported?

Exact time frames available here.

How should be reported?

Providers shall use CMS 855 or CMS20134 application forms. Sections that must be completed – 3, 5B, 6B and 7 – as it applies. CMS 855 form requires attachment of applicable documentation.

Reporting must be done even if the adverse action occurred in a different state than the provider is enrolled or seeks enrollment.

 

! Failure to comply with these requirements could result in the revocation of your Medicare billing privileges.