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Medicare Revalidation in 5 Steps

As per Section 6401 (a) of the Affordable Care Act, all enrolled providers and suppliers are required to revalidate their Medicare enrollment information under the new enrollment screening criteria.

The Revalidation Process

01 Blog Medicare Revalidation Norms and process_04-15-16 AN-02

  1. Determine which provider is being requested to revalidate
  2. View the information checklist
  3. Revalidate using Internet-based PECOS or by completing the appropriate CMS-855 application
  4. Check your application status

PECOS is the most efficient way to submit your revalidation information.  Using the Internet-based PECOS allows you not only to review information currently on file, but also update and submit your revalidation.  In order to complete your revalidation process, you will be required to either electronically sign the revalidation application or mail the paper certification statement to your MAC after signing and dating the same.  You can also upload any supporting documentation into PECOS or mail it along with your paper certification statement to your MAC.

CMS has implemented several revalidation processing improvements and norms in an effort to streamline the revalidation process and reduce provider/supplier burden, some of which are listed below.

Established Due Dates
Due dates will be on the last day of the month (i.e., June 30, 2016, July 31, 2016, August 30, 2016), by which you must revalidate.  Your next revalidation cycles will generally remain on this due date.

Posted Due Dates on Data.CMS.gov
As of March 2016, a listing of all of the currently enrolled providers/suppliers is available at: https://data.cms.gov/revalidation.  While DME supplier information will currently not include due dates and is displayed as a blank field, the rest will display a revalidation due date, if they are due for revalidation.  “TBD” (To Be Determined) will be displayed in the due date field for all other providers/suppliers not up for revalidation.  In order to provide sufficient notice and time for the provider/supplier to comply, CMS will post the revalidation due date up to 6 months in advance for each revalidation due date.

Revalidation Due Date Lookup Tool
A revalidation due date lookup tool is now available for users.  Users are also provided with the ability to download the entire data set, which can be downloaded in different formats (i.e., CSV, PDF, XLS, XLSX or XML) from: https://data.cms.gov/revalidation.

Crosswalk
Organizations that the individual provider reassigns benefits to; will also be available as a crosswalk at: https://data.cms.gov/revalidation.

Unsolicited Revalidation Submissions
Revalidation applications submitted by a provider/supplier more than six months before their due date are defined as unsolicited revalidations.  Please do not submit a revalidation application if a due date does not reflect on the file.

Revalidation Notices sent via email/mail
2-3 months prior to your revalidation due date, a revalidation notice will be sent by your Medicare Administrative Contractor (MAC) either by regular mail (at least two of your reported addresses: correspondence, special payments and/or your primary practice address) or email (to email addresses reported on your prior applications) reminding you of your due date for revalidation.

Deactivations Due to Non-Response to Revalidation or Development Requests
Your provider enrollment record may be deactivated if your application is received after the due date, or if you provide additional requested information after the due date.  A new full and complete application will need to be submitted by those providers/suppliers who have been deactivated, in order to re-establish their provider enrollment record and related Medicare billing privileges.  While the provider/supplier will maintain their original PTAN, billing will be interrupted during this period of deactivation resulting in a gap in coverage.

About the Author:MedConverge

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