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Medicare Providers Must Begin to Revalidate Enrollment By March 2013


Why Medicare Providers must revalidate their Enrollment?


In the continued effort to reduce fraud, waste, and abuse, CMS implemented new screening criteria to the Medicare provider / supplier enrollment process beginning in March 2011. All providers and suppliers who enrolled in the Medicare program prior to Friday, March 25, 2011, will be required to revalidate their enrollment under this new risk screening criteria required by the Affordable Care Act.

Newly-enrolling and revalidating providers and suppliers are placed in one of three screening categories - Limited, Moderate, or High - each representing the level of risk to the Medicare program for the particular category of provider / supplier, and determining the degree of screening to be performed by the Medicare Administrative Contractor (MAC) processing the enrollment application.

Please note: This revalidation effort applies to those providers and suppliers that were enrolled prior to March 25, 2011.

Will Providers receive any notice for revalidation?

Yes, between now and March 2013, MACs will be sending notices to individual providers/suppliers; please begin the revalidation process as soon as you hear from your MAC. Upon receipt of the revalidation request, providers and suppliers have 60 days from the date of the letter to submit complete enrollment forms. Failure to submit the enrollment forms as requested may result in the deactivation of your Medicare billing privileges.

What must be done when a provider receives notification from MAC for revalidation?

1. Update the enrollment through Internet-based Provider Enrollment, Chain and Ownership System (PECOS) or complete the 855;

2. Sign the certification statement on the application;

3. If applicable, pay the fee thru pay.gov; and

4. Mail all supporting documents and certification statement to the respective MAC.

Is there any fee imposed for revalidation? How should I pay it?

The Affordable Care Act also requires the Secretary to impose a fee on each “institutional provider of medical or other items or services and suppliers.” The application fee is $505 for Calendar Year (CY) 2011. CMS has defined “institutional provider” to mean any provider or supplier that submits a paper Medicare enrollment application using the CMS-855A, CMS-855B (except physician and non-physician practitioner organizations), or CMS-855S forms or associated Internet-based PECOS enrollment application.

Payment via Pay.Gov

All institutional providers and suppliers who respond to a revalidation request must submit an enrollment fee via Pay.Gov. You may submit your fee by electronic check, debit, or credit card. Revalidations are processed only when fees have cleared. To pay your application fee, go to http://www.pay.gov and type “CMS” in the search box under Find Public Forms, and click the GO button. Click on the CMS Medicare Application Fee link. Complete the form and submit payment as directed. A confirmation screen will display indicating that payment was successfully made. This confirmation screen is your receipt and you should print it for your records. CMS strongly recommends that you mail this receipt to the Medicare contractor along with the Certification Statement for the enrollment application. CMS will notify the Medicare contractor that the application fee has been paid.

Can I start my revalidation process before I receive a notice from MAC?

No, MACs will send out notices on a regular basis to begin the revalidation process for each provider and supplier. Providers and suppliers must wait to submit the revalidation only after being asked by their MAC to do so.

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