CMS clarifies provider termination criteria

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CMS clarifies provider termination criteria
CMS clarifies provider termination criteria

The Centers for Medicare & Medicaid Services has clarified the terms under which states can terminate a provider's participation in state Medicaid programs.

The Affordable Care Act stipulates that Medicaid terminate any individual or entity that has been terminated under Medicare or any other state Medicaid program, according to a bulletin issued by CMS. As defined by CMS, termination occurs when an action has been taken to revoke a provider's billing privileges.

Providers can only be terminated in cases where a provider's billing privileges have been revoked “for cause.” Examples of “for cause” decisions would be a provider terminated for fraud or abuse of billing privileges, the agency stated.

Click here to read the advisory.