Medicare Providers Must Begin to Revalidate Enrollment By March 2013
The Centers for Medicare & Medicaid Services (CMS) has announced that all providers/suppliers who enrolled in the Medicare program prior to Friday, March 25, 2011, will be required to revalidate their enrollment under new risk screening criteria required by health care reform legislation (section 6401a of the Affordable Care Act). New providers/suppliers who enrolled on or after Friday, March 25, 2011 have already been subject to this screening and thus need not revalidate.
This new screening criteria is designed to reduce fraud, waste, and abuse. Newly enrolling and revalidating providers and suppliers are placed in one of three screening categories—limited, moderate, or high—each representing the level of risk to the Medicare program. Due in part to AOTA advocacy, occupational therapists fall in the category representing the lowest risk: the “limited” category (see Program Integrity Manual, Ch. 15, Sec. 19.2.).
Between now and March 2013, MACs will be sending notices to individual providers/suppliers. Please begin the revalidation process as soon as you hear from your MAC. Providers and suppliers have 60 days from the date of the notice to submit complete enrollment forms. Failure to submit the enrollment forms as requested may result in the deactivation of your Medicare billing privileges. The easiest and quickest way to revalidate your enrollment information is by using Internet-based PECOS (Provider Enrollment, Chain, and Ownership System), at https://pecos.CMS.hhs.gov.
There is an application fee for “institutional” providers/suppliers (i.e., those submitting a paper Medicare enrollment application using the CMS-855A; CMS-855B, not including physician and non-physician practitioner organizations; CMS-855S; or associated Internet-based PECOS enrollment applications). These fees may be paid via www.pay.gov. To reduce the burden on the provider, CMS is working to develop innovative technologies and streamlined enrollment processes, including Internet-based PECOS. Updates will continue to be shared with the provider community as these efforts progress. For more information about provider revalidation, see the Medicare Learning Network article, Further Details on the Revalidation of Provider Enrollment Information.
If you have questions about revalidation, please contact us at rrpd@aota.org.
