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Medicare Provider Enrollment Revalidation

Have you received notification from your Medicare Administrative Contractor (MAC) to revalidate your Medicare enrollment information? If not, be prepared for it.

Section 6401(a) of the Patient Protection and Affordable Care Act requires all enrolled providers and suppliers to revalidate their enrollment information under new enrollment screening criteria. This revalidation effort applies to providers and suppliers enrolled prior to March 25, 2011. Newly enrolled providers and suppliers submitting enrollment applications to the Centers for Medicare & Medicaid Services (CMS) on or after March 25, 2011, are not affected. Between now and March 23, 2013, MACs will regularly send out notices to begin the revalidation process for each provider and supplier.

Providers and suppliers should submit revalidation only after receiving the request from their MAC to do so. Providers and suppliers will have 60 days from the date of the letter to submit the required completed enrollment forms. Failure to submit enrollment forms as requested may result in the deactivation of Medicare billing privileges. Revalidation can be completed through the Internet-based Provider Enrollment Chain and Ownership System (PECOS) or a paper application; currently, federally qualified health centers only may submit paper enrollment applications. Please note: CMS forms 855A, 855B, 855I, 855O, 855R and 855S all have been revised as of July 1, 2011, and should be used for the provider enrollment revalidation. The new forms can be found by searching “855” on the CMS website.

When you receive notification from your MAC to revalidate, you will need to complete the following steps:

  • Update your enrollment through Internet-based PECOS or complete the appropriate CMS 855 paper application.
  • Sign the certification statement on the application.
  • Submit an enrollment fee ($505 for federal fiscal year 2011) via http://www.pay.gov.
    • On the pay.gov website, enter “CMS” into the field under “Search Public Forms.” Click “Go,” and then click the “CMS Medicare Application Fee” link.
    • The enrollment fee is imposed on institutional providers that are newly enrolling, re-enrolling/re-validating or adding a new practice location; the fee only applies to applications received on or after March 25, 2011.
    • Physicians, non-physician practitioners, physician group practices and non-physician group practices (unless enrolling as a DMEPOS supplier) are not subject to the enrollment fee.
    • Payments may be submitted by electronic check or debit/credit card.
    • Fees for future years will be adjusted by the percentage change in the consumer price index (for all urban consumers) for the 12-month period ending on June 30 of the prior year.
    • If necessary, a request for a hardship exception to the application fee can be made.
  • Mail the form, supporting documents and certification statement to your MAC.
    • If using PECOS, enrollment forms are not required to be mailed to your MAC, but the certification statement and other supporting documents are required.
    • Providers and suppliers are strongly encouraged to submit a copy of their pay.gov receipt with their application. This enables the contractor to more quickly verify that payment has been made.

Additional details related to Medicare provider enrollment revalidation can be found in this CMS MLN Matters article and the Federal Register.

If you need further guidance or assistance, please contact your BKD advisor or Rebekah Wallace at rwallace@bkd.com.

This post was written by:

Monique has health care operations experience in both hospital and clinic settings. She provides reimbursement and operational consulting for physician clinics, rural health clinics and federally qualified health centers. Monique also assists in physician compensation structure analysis, operations and improvement and revenue cycle enhancement consulting.

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Recent Comment

  • Karen Vance says:
    This would be under §484.18 of the Conditions of Participation describing regulations for the Plan of Care. Below is the Standard that addresses your issue: "§484.18(b) - Agency professional staff promptly alert the physician to any changes that suggest a need to alter the plan of care." From the State Operations Manual (guidance for state surveyors) "The
    February 24, 2011 on Webinars

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