How to verify when it is time to re-validate Medicare enrollment information

August 30th, 2013 - Scott Kraft   
Categories:   Enrollment  
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As you probably know, Medicare requires individual providers as well as enrolled entities to re-validate their on-file enrollment information through March 2015. Providers who enrolled after March 23, 2011 are not impacted.

Your revalidation notice will come via a mailed letter like the sample included as a resource from this post. 

If you are not yet in Medicare’s online PECOS tool for enrollment, the letter will go to your primary practice address currently on file. When you are in PECOS, it will go to the correspondence address and the special payments address on file.

CMS will not necessarily revalidate each individual provider within an entity and the entity itself on the same schedule, so you need to constantly be on the lookout for the letters

You can also visit http://www.cms.gov/Medicare/Provider-Enrollment-and-Certification/MedicareProviderSupEnroll/Revalidations.html. At the bottom of that page, CMS publishes a file of the names to whom it has sent revalidation letters. It’s worth checking once a month to be sure you haven’t missed your letter. There is too much at stake.

Revalidation places a special burden – you won’t get much advance notice of the request to revalidate, but a failure to do so carries heavy risk because Medicare can suspend the billing privileges of any provider or entity that fails to respond to a revalidation request within 60 days of the postmark. You are allowed one 60-day extension request by sending a written notice to the MAC directly from the provider or designated official of the entity.

But the reality is, it’s a complicated enrollment update if you haven’t done it in a while and the 60 days will go by quickly. What CMS aims to accomplish through revalidation is more accurate, centralized enrollment data. This includes updating addresses of practice locations, removing physicians no longer active and purging facilities no longer in operation. All things that are supposed to be done within 30 days of the changes, but often slip.

One more thing to remember: CMS does not currently permit anyone to change a provider’s information in the PECOS system other than the provider itself, though the agency has been working on a policy to allow someone to make the change on behalf of the provider.

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