Experience. Integrity. Advocacy.
Experience. Integrity. Advocacy.

Medicare Revalidation Process Affects Most Providers

Medicare revalidation, a provision of the Affordable Care Act, affects all providers and suppliers who were enrolled with Medicare prior to March 25, 2011. According to the provision, all of these providers and suppliers must revalidate their enrollment using Medicare’s new screening criteria by March 23, 2015.

Medicare administrative contractors are sending out letters on a regular basis to trigger a provider’s revalidation. Only once the letter is received can a provider proceed. The first letters were sent out in Fall 2011; lists of all providers to whom letters have been sent so far are available on the CMS website. The most recent list for letters mailed in February and March 2012 was added earlier this month.

The first wave of validation letters was sent to providers not in PECOS and was mailed to their special payments or primary practice address. For those providers in PECOS, the validation letters is supposed to be sent to both the special payments and correspondence addresses simultaneously. If these are the same, then the letters will also be mailed to the primary practice address.

According to an MLN Matters from 2011, when providers receive their letters, they should follow these steps for revalidating:

  • Update your enrollment through internet-based PECOS or complete the 855;
  • Sign the certification statement on the application;
  • Pay any applicable fees;
  • Mail supporting documents and certification statement to your MAC.

For providers under Medicare Part A and B in Indiana and Part A in Michigan, the change in MACs from NGS to WPS later in the summer will not disrupt the revalidation process. Providers who receive a letter should return it to NGS prior to and to WPS after the cutover dates.

As part of our credentialing services, CIPROMS is helping our clients walk through the revalidation process by regularly comparing the CMS lists of letters sent with our master list of clients, notifying clients to be on the lookout for the revalidation letters, and helping providers with all the necessary steps and paper work for revalidation.

For additional information on the Medicare Revalidation Process, visit the Revalidations page of the CMS.gov website.

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Charity Singleton Craig

Charity Singleton Craig is a freelance writer and editor who provides communications and marketing services for CIPROMS. She is responsible for creating, editing, and managing all content, design, and interaction on the company website and social media channels in order to promote CIPROMS as a thought leader in healthcare billing and management.

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