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Medicare Revalidation Alert

MEDICARE REVALIDATION ALERT

Section 6401(a) of the Affordable Care Act (“ACT”) established a requirement for all enrolled providers and suppliers to revalidate their enrollment information under new enrollment screening criteria.  This revalidation effort applies to those providers and suppliers that were enrolled prior to March 25, 2011.  Newly enrolled providers and suppliers that submitted their enrollment applications to CMS on or after March 25, 2011 are generally not impacted.

CMS has reevaluated the revalidation requirement in the ACT and believes it affords the flexibility to extend the revalidation period for another two (2) years.  This, according to CMS, will allow for a smoother process for providers and contractors.  Revalidation notices, which started to be sent out on September 2, 2011, will be sent through March 2015.  This extension of the period for completing the revalidation process, does not affect those providers to whom notices have already been sent.

Accordingly, between September 2, 2011 and 2015, Medicare Administrative Contractors (“MACs”) will send out revalidation notices on an intermittent, but regular basis to begin the revalidation process for each Medicare provider and supplier.  Providers and suppliers must submit the revalidation application only after being asked by their MAC to do so.

Medicare providers and suppliers will be required to submit a completed CMS Form 855 with supporting documentation within 60 days of the request. In addition, a filing fee is required to be paid. After the 855 is filed, the MAC will review the form and initiate screening requirements. For some providers the screening requirement will include a site visit. These visits are not for survey and certification purposes. Failure to submit the completed CMS Form 855 and the required documentation within 60 days of the request can result in deactivation of Medicare billing privileges.

The Health Group, LLC has completed numerous CMS Form 855s, including the forms as revised in July 2011.  For services available through The Health Group, LLC click here.