Healthcare: Some Medicare Providers Must Revalidate Privileges
8/26/2011
Medicare providers enrolled in the program prior to March 25, 2011 will be required to revalidate their privileges under new risk screening criteria required by the Affordable Care Act (“ACA”). (Providers that enrolled on or after March 25, 2011 have already been subject to this screening and need not revalidate at this time.)
Revalidation notices are being sent directly to the providers by Medicare Administrative Contractors (“MACs”) between now and March 2013. A provider’s failure to respond within 60 days will deactivate its Medicare privileges. Do not risk enrollment deactivation due to non-receipt of these notices. Providers should contact their Fiscal Intermediary or MAC today to confirm the most up-to-date contact information is on file.
Upon receipt of the revalidation notice, a provider must:
- Update their enrollment through Internet-based Provider Enrollment, Chain and Ownership System (PECOS), or complete the CMS-855;
- Sign the certification statement on the application;
- If applicable, pay their fee through pay.gov (The ACA requires institutional providers to pay an application fee —of $505 for 2011—when enrolling or revalidating. Physicians and non-physician organizations are exempt from the revalidation application fee.); and
- Mail their supporting documents and certification statement to their MAC.
For additional information on this topic, please visit the Medicare Learning Network Matters notice on this topic at
http://www.cms.gov/MLNMattersArticles/downloads/SE1126.pdf and Change Request (CR) # 7350.
For further information about this or other issues that may impact your business, please contact Peter R. Epp, managing director of J.H. Cohn’s Healthcare Industry Practice, at pepp@jhcohn.com or 646-254-7411; Dolores DiRe, manager, at ddire@jhcohn.com or 646-625-5703; or your J.H. Cohn engagement partner at 877-704-3500.