CMS Rule: Prevent Losing Your Medicare Billing Privileges


CMS regulations require your Medicare enrollments be judged not necessarily on your performance but based on your affiliations with other providers and suppliers.

If you have a provider or supplier affiliation that has committed “bad acts,”  you could be considered to be an increased fraud, waste, or abuse risk. If this happens, CMS is authorized to deny or revoke your Medicare and Medicaid billing privileges. This Rule went into effect on November 4th, 2020. It’s essential that you thoroughly understand how to avoid getting blindsided because of an affiliate’s wrongdoing. You must know how to protect your practice from losing its ability to bill Medicare and Medicaid.

This is where Medicare expert, Gretchin Heckenlively, CPA, FHFMA, can help. During her online training session, Gretchin will walk you through this CMS Rule, and tell you EXACTLY what you need to know to protect your practice from harm. This training spells out the actions you must take to prepare yourself for the full implementation of this Rule, and how you can head off Medicare and/or Medicaid revocation.

Here are a few of the practical, plain-English CMS Rule strategies you’ll receive by attending this 60-minute online training:

  • Determine which of your relationships constitute an “affiliation” under the rule
  • Pin down exactly what constitutes a “disclosable event”
  • Don’t let one provider’s revocation stop your other provider’s ability to bill Medicare
  • Don’t let a provider’s “degree of commonality” get your enrollment application denied
  • Prevent “false storefront” allegations due to a failure to update your enrollments on time
  • Set up a screening process for future affiliates to head off billing problems
  • Stop missed reporting deadlines from leading to revocation
  • And much, much more…

Although CMS has stated that “any decision to revoke will not be taken lightly,” it’s clear that with these new requirements and consequences, there will be an increase in enrollment and attestation denials. To protect your practice, you must implement the changes from this upcoming online training or risk getting kicked out of Medicare.

The increased consequences for non-compliance with CMS’ Rule means that you could lose your ability to see Medicare and Medicaid patients for up to 20 years.  Don’t let this happen to you and your practice. Sign up for this expert-led online training to pin down what and how you must prepare.

Meet Your Expert

Gretchin S. Heckenlively
CPA, FHFMACPA and Partner, Seim Johnson, LLP

Gretchin is a CPA and Partner in the Health Care Consulting division at Seim Johnson, LLP. She joined the firm in 1997 in the HealthCare Audit Division providing audit and Medicare/Medicaid cost reporting services on over 100 engagements.

In 2006, Gretchin left Seim Johnson to pursue an opportunity as the Chief Financial Officer of a critical access hospital. There she gained valuable experience in both the financial and clinical arenas of a hospital.

Gretchin rejoined the firm in 2010, and since that time, she has been able to bring frontline knowledge and understanding of working in a healthcare environment to the consulting division. Her focus is on Medicare and Medicaid provider enrollment, Medicare provider-based issues and reimbursement.

Gretchin has given many presentations on a wide range of healthcare, and not-for-profit related topics at a local, state and national level and currently serves on the CMS Central Office PECOS Focus Group and the CMS Central Office Provider Compliance Focus Group.

Also, she is an active member of Healthcare Financial Management Association (HFMA) and is a past President of their Nebraska Chapter. She also served as the Treasurer of HFMA Region 8. Gretchin graduated from Doane College in May 1997 with a Bachelor of Science Degree in Accounting and Finance.


The webinar was informative and the speaker was knowledgable.
Joanne Adam
CCS Manager, University Orthopaedic Associa
The information was very helpful.
Dana Cannon
Credentialing, LifeLinc Anesthesia, PLLC
Very informative! Speaker was easy to understand.
Daphne McDowell
Credentialing, Kentucky Eye Care PSC
The speaker explained the Final Rule comprehensively.
Tia Payne
Compliance Officer/Privacy and Security Officer, Physician Revenue Navigators