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CMS clarifies types of providers impacted by provisional period of enhanced oversight

CMS has re-released an MLN Matter article to confirm the decision to suppress payments associated with requests for anticipated payment (RAPs) for new agencies also impacts existing agencies that have undergone a change of ownership.

MLN Matters article SE19005 was originally released Feb. 15 and provided information about CMS’ placement of new agencies into a “provisional period of enhanced oversight.” At the time, the article stated that CMS could place new agencies into a provisional period immediately.

CMS re-released the article Oct. 25, clarifying that when it comes to the provisional period of enhanced oversight, “‘new’ providers includes all initial enrollments, changes of ownership (CHOWs) that fall under 42 C.F.R §489.18, and changes of information reporting a 100% ownership change.”

The federal Medicare agency began placing new agencies into a provisional period of enhanced oversight immediately after the article was first issued, the Oct. 25 update states.

CMS’ oversight includes suppression of all RAP payments for 30 days to a year. Each new agency will receive individual notice about how long it will be in this provisional period.

Affected agencies still must submit RAPs for each episode in order for CMS to process final claims. But agencies won’t be paid for an episode until after submitting the final claim.

Related link: Read the MLN Matters article at https://go.cms.gov/2DLYk71.