New enrollment screening criteria under the Affordable Care Act requires regular revalidations for all providers enrolled in the Medicare program. The Centers for Medicare and Medicaid Services (CMS) is wrapping up its first round of Medicare revalidations (final notices were mailed on March 23, 2015, and applications processing will be finished shortly) and has begun notifying providers of round two revalidation deadlines.
For round two Medicare revalidations, CMS has streamlined the process. All revalidation due dates will be the last day of the month, and providers can submit their revalidations up to six months prior to the due date. Assigned due dates for round two revalidations will generally stay the same for subsequent revalidations. Due dates are established based on the last successful revalidation or initial enrollment and will be scheduled every 3 years for DME suppliers and 5 years for all other providers/suppliers.
Providers will be notified of their assigned revalidation deadline in several ways. First, a list of Medicare providers and suppliers is posted on the Medicare Revalidation website. As due dates are assigned, they are added to the list. (Until a deadline is assigned, the provider’s “Revalidation Due Date” column will show TBD.) In addition, Medicare Administrative Contractors (MACs) will send revalidation notices within 2-3 months prior to the revalidation due dates either by email first (if email addresses have been reported on prior applications) or regular mail for those who do not have an email address on file or if the email was returned as undeliverable. Once a due date has been assigned, the revalidation will be due even if the provider does not receive an emailed or mailed notification. Providers should periodically review the Medicare Revalidation website to see if a due date has been added.
To submit a revalidation application, providers can use CMS’s Internet-based PECOS or complete the appropriate CMS-855 application. In both cases, providers should also submit all supporting documentation before the due date as well. Institutional providers of medical or other items or services and suppliers are required to submit an application fee of $554 for revalidations. However, this fee does not apply to physician and non-physician practitioner organizations.
Three Important Things to Note
- When a provider receives a due date for revalidation, that provider must revalidate his entire application and include all groups he reassigns benefits to. Large groups (200+ members) will receive special notification of all members who are up for revalidation over the upcoming six-month period, but when those members are revalidated, information about any other groups they are reassign benefits to should be included on the application as well. A list of reassignments of providers who are due for revalidation is available on the Medicare Revalidation website.
- All unsolicited revalidation applications (or those submitted more than 6 months in advance of the provider/supplier’s due date) will be returned. If you need to submit a change to your provider enrollment record prior to your revalidation, simply submit a ‘change of information’ application using the appropriate CMS-855 form.
- Providers who do not submit their revalidation application, supporting documentation, or additionally requested information by their due date face a hold on their enrollment or even deactivation from the Medicare program. Deactivated providers/suppliers will be required to submit a new full and complete application in order to reestablish their provider enrollment record and related Medicare billing privileges. The provider/supplier will maintain their original PTAN; however, an interruption in billing will occur during the period of deactivation resulting in a gap in coverage.
For more information about Medicare Revalidation, visit the Medicare Revalidation website or review slides from the recent MLN Connects Provider Enrollment Revalidation – Cycle 2 National Provider Call.
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