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Pay Attention to Medicare Revalidation Letters

Jul 2, 2014

By Nancy Clark, CPC, CPB, CPMA, CPC-I

Section 6401(a) of the Affordable Care Act (on Page 685) established a requirement for all enrolled providers and suppliers to revalidate their Medicare enrollment information under new enrollment screening criteria. This revalidation effort applies to those providers and suppliers that were enrolled in Medicare prior to March 25, 2011.

The Centers for Medicare and Medicaid Services (CMS) require a provider, supplier, or organization to verify the accuracy of its enrollment information every five years.  At times, “off-cycle” revalidations may be required.  These unexpected revalidations may be caused by health care fraud issues, national initiatives, complaints, or reasons that would cause CMS to question the compliance of the provider or supplier.  Random reviews are also a possibility.

Failure to submit the appropriate required enrollment forms may result in the deactivation of Medicare billing privileges.  Providers should submit the appropriate CMS-855 form in conjunction with any other requested information.  Additional document requests include a CMS-588 Electronic Funds Transfer Authorization Agreement form and a copy of IRS CP-575, or other appropriate certification of the business’ employer identification number (EIN).

Currently, CMS is actively targeting providers who are not registered in the Medicare Provider Enrollment, Chain, and Ownership System (PECOS), in order to facilitate inputting the provider’s data.  They are also pursuing providers who do not currently receive electronic funds transfer (EFT) payments, and those who have not updated their enrollment in the last five years.
In order to comply with ongoing Medicare regulations, providers should report any significant changes to their Medicare Administrative Contractor (MAC) on a timely basis.  These changes include a change in ownership, practice location, billing service or correspondence address.

Providers are encouraged to review all correspondence from CMS on a timely basis.  Keep in mind, though, that a revalidation should not be submitted prior to receipt of a request from Medicare.  For more information on Medicare Revalidation please click here

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