Provider Enrollment Validation – Cycle 2

The Centers for Medicare and Medicaid Services (CMS) require that providers periodically revalidate their enrollment in Medicare. On April 18, 2016, CMS announced that they had completed the initial round of revalidations. The first of the “Cycle 2” revalidations are due to begin May 31, 2016. CMS notes that the next revalidation cycle has a number of changes.

Notably, CMS has added a Revalidations website page.

  • If you usually receive notice via email or postal mail, that will still happen. Your Medicare Administrative Contractor (MAC) sends these within 2-3 months of your revalidation date.
  • The simplest and fastest way to revalidate is using PECOS on line.

Generally, CMS instructs that you should not submit a revalidation unless you receive notice. However, there are severe penalties for not revalidating in a timely manner.

IMPORTANT: Failure to revalidate in a timely manner will result in a possible hold on your Medicare payments or even deactivation of your Medicare billing privileges.

If you are within 2 months of your revalidation date but have not received a notice, you are encouraged to submit your revalidation proactively. Fortunately, you can now check whether you should have received a revalidation notice.

To verify your revalidation date or to see if you should have received a notice, use CMS’s new Medicare Revalidation Lookup Tool. CMS notes this “is a searchable database … to look up an Individual Provider or Organization”:

  • by Last Name, First Name or Organization Name
  • by NPI of an Individual Provider or Organization

If “To be determined” or “TBD” is displayed, you are not due to revalidate within 6 months. Check the website periodically.

Durable Medical Equipment Prosthetic and Orthotic Supplies (DMEPOS) suppliers will not display a due date; instead, DMEPOS suppliers will receive communication from the National Supplier Clearinghouse (NSC) identifying when their revalidations are due.

As always, if you need assistance, Corcoran Consulting Group can help. Visit our website or call us to learn more. You can access our new App, Corcoran 24/7 via the links below.

www.corcoranccg.com (800) 399-6565

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