This week, ASCRS joined members of the Alliance of Specialty Medicine in a letter to CMS Administrator Seema Verma expressing concerns that disclosure requirements in its final rule, “Medicare, Medicaid, and Children's Health Insurance Programs; Program Integrity Enhancements to the Provider Enrollment Process,” are overly burdensome and may prevent specialty physicians from participating in Medicare.
In the rule, CMS finalized a “phased-in” approach to implementing new program integrity requirements for disclosure of affiliations with disclosable events, rather than requiring disclosures by every newly enrolling or revalidating provider or supplier. While we applaud CMS for its policy, which reduces burden for the majority of physicians, we remain concerned that the finalized disclosure requirements on specialty physicians to participate in the Medicare program would erect new barriers to the practice of medicine and increase compliance risk. Specifically, CMS finalized that upon request, physicians would be required to disclose any and all “affiliations” they had within the previous 5 years with a currently or formerly enrolled Medicare, Medicaid, or Children’s Health Insurance Program (CHIP) provider or supplier that has ever had a “disclosable event.” If CMS determines that any of the disclosed affiliations poses an undue risk of fraud, waste, or abuse, then the agency would deny or revoke the provider’s or supplier’s Medicare enrollment. The Alliance asserts many specialty physicians who are targeted for disclosure reporting will experience difficulty not only identifying and tracking affiliations for a rolling 5-year period, but also ascertaining whether such affiliations have been subject to disclosable events at any point in time.
We urge CMS to carefully evaluate the usefulness of this data and whether changes can be made to reduce the scope of data required for reporting. Additionally, we ask CMS to work with specialty physicians to develop guidance for determining the existence of disclosable events among their affiliations.