Medicare Revalidation Coming to a Close; Now What?

The Patient Protection and Affordable Care Act required a revalidation, or a re-enrollment, for all Medicare providers enrolled prior to March 25, 2011. Medicare Administrative Contractors (MAC) have been contacting providers, and once they receive their revalidation notice, providers have 60 days to respond. The massive special revalidation is expected to be completed by March 2015.

Failure to complete the revalidation process will result in a suspension of Medicare enrollment and billing privileges. To reactivate enrollment and once again begin receiving payments, the provider must complete the revalidation.

If you have not yet completed a revalidation with Medicare, follow these steps:

1. Determine whether or not  you were enrolled prior to March 25, 2011. If you were enrolled after that date, you do not need to participate in this initial revalidation.
2. If you were enrolled prior to March 25, 2011, determine if you have been sent a revalidation letter. The Centers for Medicare and Medicaid Services maintains a list of all providers who have been mailed a revalidation letter (review the downloads section at the bottom of the CMS Revalidation webpage).
3. If you have not received a letter and you do not find yourself or your practice on the list of providers to whom letters have been sent, be on the lookout for your letter over the next few weeks. Letters are supposed to be mailed in a yellow envelope to help them stand out.
4. If you have received your letter and/or find your name on the list, follow the steps on the revalidation checklist to complete your revalidation.
5. If you suddenly stop receiving payments from Medicare, first check to see if they are awaiting your revalidation. The only way to resolve the stopped payments is to revalidate.

After this initial revalidation, Medicare guidelines require providers to be revalidated every 5 years. According to the Q&A section of the External Users Service website for Medicare Providers, the ongoing revalidation will be done on the anniversary of a provider’s approved Provider Enrollment, Chain and Ownership System (PECOS) enrollment. Durable Medical Equipment (DME) suppliers will be required to revalidate every 3 years. Per Medicare guidelines, MACs will notify providers/suppliers at least 60-days prior to their revalidation date.

For more information about Medicare Revalidation, review the following resources:

• The Basics of Internet-based Provider Enrollment, Chain and Ownership System (PECOS) for Provider and Supplier Organizations – FACT SHEET
• The Basics of Medicare Enrollment for Physicians and Other Part B Suppliers – FACT SHEET
• The CMS Announcement about Medicare Participation for Calendar Year 2015

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