CMS Enters Cycle 2 for Provider Enrollment Revalidations
March 4, 2016 10:58 AM
The Centers for Medicare & Medicaid Service (CMS) has completed the first cycle of revalidation requests for all Medicare providers and supplies and are now entering a regular cycle (Cycle 2) of provider enrollment revalidations.
CMS has posted a listof all currently enrolled providers and supplies which will include the revalidation date for each provider/supplier six months prior to their due date. All others will have a date of “TBD” until they reach six months prior to the date for revalidation. Due dates are established based on the date of the last successful revalidation or initial enrollment. For a durable medical equipment supplier that is 3 years and for all other providers/supplies it is 5 years. The due date will generally be on the last day of the month.
The list identifies billing providers/suppliers only that are required to revalidate. Providers enrolled solely to order, certify, and/or prescribe via the CMS-855O application or have opted out of Medicare, will not be required to revalidate and will not be reflected on the list.
The Medicare Administrative Contractors (MAC) will notify providers/suppliers 2-3 months prior to the revalidation due date, either by regular mail or e- mail. Revalidation notices sent via email will indicate “URGENT: Medicare Provider Enrollment Revalidation Request” in the subject line to differentiate from other emails. If all of the emails addresses on file are returned as undeliverable, the MAC will send a paper revalidation notice to at least two reported addresses: correspondence, special payments and/or primary practice address.
Providers /suppliers are responsible to revalidate by their due date even if they do not receive any correspondence from their MAC. Therefore, providers/suppliers are encouraged to keep track of their revalidation date and use the CMS revalidation list and tools.
If the provider/ supplier fails to revalidate by the due date, they will have an additional 60-75 days to submit their revalidation application before becoming deactivated. A critical aspect, however, in cycle 2 is that once a provider/supplier has been deactivated there will no longer be a 120 day grace period before there is a gap in coverage. A gap in coverage will occur from the date of deactivation until receipt date of the new full and complete application. In addition, provider/suppliers will not be issued a new PTAN when deactivated.
For home health agencies it is important to confirm that the ordering physician have an active enrollment record prior to accepting the referral. Since there is no longer a grace period before a gap in coverage occurs, retroactive billing privileges back to the period of deactivation will notbe granted. Home health claims will be denied if the physician listed on the claim has been deactivated as of the “from” date on claim.
For more information see MLN Matters Article SE1605
A National Provider Call was conducted on March. A transcript and audio recording of that call will be available in approximately two weeks here.