Medicare Revalidation Update

On November 4, 2013, CMS issued a notice of revision to reflect the current revalidation process.  Revalidation applies to all providers and suppliers who enrolled with Medicare prior to March 25, 2011.  Affected providers and suppliers must revalidate their information on file with CMS by March 2015.

CMS has announced that between now and 2015, local Medicare carriers (referred to as MAC’s) “will send out revalidation notices on an intermittent, but regular basis to begin the revalidation process for each provider and supplier.”  Furthermore, “Providers and suppliers must submit the revalidation application only after being asked by their MAC to do so”.

Where will letters be mailed?

For providers NOT in PECOS – the revalidation letter will be sent to the special payments or primary practice address because CMS does not have a correspondence address.

For providers in PECOS – the revalidation letter will be sent to the special payments and correspondence addresses simultaneously. If these are the same, it will also be mailed to the primary practice address. If you believe you are not in PECOS and have not yet received a revalidation letter, contact your MAC. Contact information may be found at on the CMS website.

CMS will provide the MACs with a list of providers/suppliers requiring revalidation every 60 days beginning October 2013. Within 60 days of receiving the CMS list, MACs will mail the revalidation notices.

Providers and suppliers have 60 days from the date of the revalidation letter to submit the complete enrollment package (including fee payment when necessary).  A 60 day extension is available if more time is needed to complete the revalidation process.  Extension requests must be submitted to your MAC in writing (fax/email permissible) or via phone.

The burden is on the Provider or supplier to submit revalidation applications within 60 days of the date of the issued revalidation letter.  MAC’s do not have any further responsibility of notification prior to terminating a provider’s billing privileges.  So, it is important that every Provider and Supplier alert staff to be on the lookout for a revalidation notice from CMS if you have not yet revalidated your information.  You can proactively search information on the CMS website to determine if a revalidation letter has been mailed.