Hospitals are concerned about the administrative burden posed by a proposed CMS rule that would ban them from Medicare and Medicaid if they fail to disclose that they are working with providers or suppliers who have been barred from the programs, or who owe money to the government.
The rule implements a provision of the Affordable Care Act requiring anyone doing business with Medicare, Medicaid and the Children's Health Insurance Program (CHIP) to disclose any current or previous direct or indirect affiliation with a provider or supplier that has uncollected debt, or that has been suspended, excluded or had billing privileges revoked by a federal healthcare programs.
Trinity Health, a system with national reach based in Livonia, Mich., said the proposal would “significantly increase” its administrative burden and costs. “It is not clear that these changes will deliver the intended benefit to improve quality and protect program integrity as CMS intends,” Trinity said in a comment letter.
Trinity was among about 60 organizations that submitted comment letters on the proposed rule before the April 25 deadline.
A consistent concern raised in the letters was that the CMS wants healthcare organizations to track and evaluate “reassignment relationships.” That's when a provider or supplier assigns the payment rights to another provider or supplier—for example, when a radiologist performs interpretations of diagnostic tests performed for a hospital's patients, and submits a bill under that hospital's billing code.
CMS officials said in the proposed regulations that it has concluded that the relationships in those scenarios are sufficiently close that participating providers should be held accountable for them.
“It amounts to commanding providers and suppliers to find a needle in a haystack or risk facing the death penalty,” said Anthony Burba, a partner at Barnes & Thornburg. “I could see this creating an enormous compliance burden on larger providers, such as hospitals and health systems.”
Hospitals and health systems that submitted comments said they generally back the agency's desire to hold them accountable for their business relationships—for example, when they have a significant ownership stake in an entity or exercise operational control over it. But they strongly opposed extending the scrutiny to reassignment.
Carolinas HealthCare System, based in Charlotte, N.C., said in a comment letter that thousands of suppliers have reassigned payments to the system and would have to be evaluated under the rule.
“The administrative burden required to collect, analyze, and report this volume of information would greatly exceed the minimal amount of fraud, waste and abuse this disclosure might prevent,” Carolinas HealthCare stated.