Tucked away in the Centers for Medicare and Medicaid Services (CMS) CY 2026 Home Health and DMEPOS final rule, CMS finalized several updates to Medicare provider enrollment. Key provisions that infusion providers serving Medicare patients should know include the following:
- New Basis for Enrollment Revocation
- CMS may take away a provider’s Medicare enrollment if a Medicare patient attests that an item or service billed on a claim was not actually provided.
- Expanded Use of Retroactive Revocation
- CMS has expanded the circumstances under which they can revoke a provider’s Medicare enrollment retroactively. Key scenarios include:
- For giving false or misleading information on their Medicare enrollment paperwork, CMS can revoke a provider’s enrollment going back to the day the provider signed the application.
- For failing to timely report required changes (i.e., ownership changes, adverse legal actions, or practice location changes), CMS can revoke enrollment going back to the day after the reporting deadline passed.
- If a provider surrenders their DEA certificate of registration because they’re facing formal disciplinary action, CMS can revoke their enrollment going back to the day of surrender.
- If a state suspends or takes away a provider’s right to prescribe certain drugs, CMS can revoke their enrollment going back to the date the state’s action took effect.
- CMS has expanded the circumstances under which they can revoke a provider’s Medicare enrollment retroactively. Key scenarios include:
- Stay of Enrollment Following Application Rejection
- CMS can temporarily pause a provider’s Medicare enrollment and billing privileges (also known as a ‘stay of enrollment’) if a change of information or revalidation application is rejected due to being incomplete or having missing information.
- Shortened Timeframe for Reporting Adverse Legal Actions
- All providers and suppliers will have 30 days, rather than up to 90 days, to report adverse legal actions to CMS.
To read the full finalized rule, click here.
