ACR shares comments on CMS provider enrollment proposed rule

The American College of Radiology (ACR) has published its comments on the proposed rule CMS released in February, Program Integrity Enhancements to the Provider Enrollment Process (CMS-6058-P). CMS said the rule was created as part of the ongoing effort to keep “questionable providers and suppliers” from entering Medicare and make it easier to quickly identify “instances of improper behavior.”

The ACR’s comments began by stating the organization supports efforts to keep fraudulent individuals and entities out of Medicare, but the proposed rule places “an undue burden” on physicians and providers.

“Specialties such as radiology would have particular challenges in identifying and collecting certain required information because they render patient care based on referrals from numerous different sources annually,” the comments read.

One of the ACR’s primary concerns about the rule is related to the five-year “look-back” period for previous affiliations. As the rule is currently written, the ACR said, radiology practices would be required to maintain records on any disclosable events for each affiliation going back to the beginning of the affiliate’s practice.

“Regardless of a physician’s level of involvement with an affiliated provider the burden and cost of researching each relationship would be roughly the same,” the comments read. “The ACR recommends that CMS exempt referral-dependent specialties from the rule. Alternatively, CMS should consider establishing a finite look-back period to assist such specialties to comply more readily with the proposed rule.”

The ACR also comment on CMS’s request for comment on a potential “reasonableness standard” for reporting disclosable events. The ACR notes that this standard would serve two purposes--creating a threshold for assessing how practices should investigate affiliations and offering protection to certain providers--but could have a negative effect as well.

“Issuing a standard for ‘reasonable’ effort inadvertently might offer a potential benchmark for those this rule is seeking to uncover and untenably exposes an honest provider to a level of risk this rule does not intend,” the comments read. “The ACR believes that most medical practices would strive to meet any reasonableness standard, but as this would entail additional practice costs, practices may lack the resources to meet an excessive standard. A clearly delineated standard would signal those individuals and entities engaged in fraudulent behavior exactly how far away to keep their information, thus increasing the chances that innocent providers are unknowingly associated with unethical entities. The ACR recommends that the Agency base any reasonableness standard on the presumption of good faith and not a complex process.”

The ACR’s comments were signed by William T. Thorwarth, Jr., MD, ACR CEO. They can be read in full on the ACR’s website.