Article

Compliance

Put CMS revalidation on your radar

Keep tabs on this to avoid having your Medicare billing privileges deactivated.

Provider and supplier revalidation is required to maintain Medicare billing privileges. The purpose of this process is to ensure that Medicare enrollments reflect current, valid information about the provider or supplier.

A provider or supplier must resubmit and recertify the accuracy of its enrollment information in general every five years. Exempt from this rule are suppliers of Durable Medical Equipment Prosthetic and Orthotic Supplies (DMEPOS), such as those with an optical, who must revalidate this accreditation at least every three years.

Meanwhile, the Centers for Medicare & Medicaid Services (CMS) continues to work on defining the due dates for provider and supplier revalidation based on their initial enrollment or revalidation, as noted in a frequently asked questions (FAQs) document published by CMS earlier this year (tinyurl.com/OPCompSep19 ). Note that some providers may be asked to revalidate sooner than the five years. In addition to the five-year cycle, CMS reserves the right to conduct “off-cycle” revalidations in accordance with 42 CFR §424.515.

Revalidation notice

Providers and suppliers can check their revalidation due dates by accessing the Medicare revalidation lookup tool at /data.cms.gov/revalidation . Once at the website, enter the provider name or National Provider Identifier. A due date result of “TBD” means that CMS has not set the date. The revalidation tool is updated every 60 days, so practices should periodically check the tool. When revalidation is due, a list will appear with provider names and corresponding due dates.

Revalidation notices are emailed, stating “URGENT: Medicare Provider Enrollment Revalidation Request” in the subject line to differentiate it from other emails. Should that email return as undeliverable, your Medicare Administrative Contractor (MAC) will send a paper revalidation notice to at least two of your reported addresses, such as correspondence, special payments, and/or primary practice address.

Revalidation process

The most efficient way to revalidate is to use the Medicare Provider Enrollment, Chain, and Ownership System (PECOS) website (pecos.cms.hhs.gov ). A paper application (CMS-855) submitted to the practice’s MAC also is an acceptable method of revalidation.

Providers and suppliers are required to revalidate the entire Medicare enrollment record during this process. Failure to submit the required information and related documents will result in a processing delay. If additional supporting documentation is requested, you have 30 days to respond.

If you fail to respond or do not submit your revalidation by the due date, your Medicare billing privileges will be deactivated. The advanced revalidations notices issued by the MACs should provide providers and suppliers adequate time to submit their application and for it to be received prior to the due date.

MACs will no longer allow providers and suppliers extension requests to complete their revalidation.

It is equally important not to submit a revalidation application too far in advance — when no due date is listed. This application will be viewed as unsolicited and will be returned to you.

Recommendation

Knowing the ramifications of failing to revalidate, do not let this requirement slip through the cracks. No provider or supplier is exempt from revalidation, so keep tabs on your due date and submit your application on time.

For further instruction, read the entire CMS FAQ. OP