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CMS rule: A closer look at affiliation reporting for managers

As noted in a previous post, the Centers for Medicare and Medicaid Services (CMS) has a new rule that allows the agency to penalize those who fail to disclose affiliations with those who have had enrollment to Medicare or Medicaid previously revoked or denied.

Medical professionals and those within the health care industry have voiced many concerns over this new rule. Many of these concerns center around the agency’s definition of an “affiliation.” To help provide some clarity, the CMS responded to some of these questions. Some of the more notable discussions included those who serve in managerial positions over labs and medical professionals.

Why does the CMS require facilities report lab managers?

A number of commenters pushed back on required disclosure of lab managers as lab managers conduct day-to-day operations of the lab and are not connected to the payment side of operations.

The agency did not agree. It stated the requirement does not specify those who have connection to payment. Instead, the rule, whether fairly or not, requires the reporting of all those who conduct day-to-day operations. As a result, lab managers fall within this requirement.

Does a physician director qualify as an “affiliation” for the purposes of this rule?

The rule requires disclosure when the party has managerial control over day-to-day operations. As a result, health care professionals’ question whether or not the rule requires organizations to report qualifying individuals who held positions as a physician director or director of nursing.

In certain situations, the rule requires reporting of these individuals. For example, the CMS would require reporting if the physician director or director of nursing holds a position as a managing employee and the individual held a previous managing employee position within an organization that had a disclosable event.