January 17, 2019
Centers for Medicare and Medicaid Services (CMS) recently created and published a Preclusion List of providers and entities who are precluded from receiving payments for Medicare and Medicare Advantage (MA) items and services. In addition, prescriptions written by prescribers on the Preclusion List will not be covered as Medicare Part D drugs. The new rule is CMS’s alternative to the Medicare Advantage Prescriber Enrollment mandate CMS previously considered.
Things to know about the new rule:
- CMS notifies providers and entities of their potential inclusion on the Preclusion List in advance of list publication. The notification informs them why they’re on the list, how long they might remain on the list, and their appeal rights.
- MA plans are required to notify members who’ve received services from or prescriptions written by providers on the list that they can’t continue to receive care from the provider and that they’ll need to choose a new provider.
- MA plans will begin rejecting or denying applicable claims for any individual or entity effective 90 days after they’ve been published on the list.
- CMS will update this list monthly.
- To learn more, visit CMS.gov and review information on their website about the Preclusion list. CMS also has a Preclusion list FAQ for providers.