QUESTION:
One of our doctors just received a letter that his Medicare billing privileges have been revoked.  What does this mean and is there anything that can be done about it?

ANSWER FROM HORTYSPRINGER ATTORNEY DAN MULHOLLAND:
Medicare billing privileges can be revoked for a variety of reasons listed in 42 CFR §424.535 but revocation of billing privileges is not the same thing as being excluded from Medicare. So, your hospital and the physician’s employer do not have to terminate any contracts they have with him.  However, it is always a good idea to double-check the OIG exclusion list just to make sure.  Moreover, revocation of Medicare billing privileges does not affect the physician’s ability to submit claims to non-Medicare payers using his NPI, and the physician can still provide locums coverage for other physicians as long as claims are not submitted under the name and NPI of the physician whose billing privileges were revoked.

Revocation of Medicare billing privileges usually is only in effect for a finite period of time, after which the physician can reapply for Medicare enrollment.  In addition, the physician can request that the Medicare Administrative Contractor (“MAC”) reconsider the revocation within 65 days of the date of the revocation and also ask for an extension of time to do so pursuant to 42 CFR §498.22.

Revocation of Medicare billing privileges is a serious matter and can cause a lot of disruption beyond just losing revenue.  But it is far less onerous than getting excluded from Medicare and there are opportunities to get reinstated.  Of course, like other situations dealing with the Government, don’t try this at home without close adult legal supervision.

If you have a quick question about this, e-mail Dan Mulholland at dmulholland@hortyspringer.com.