Save Your Practice. Avoid Medicare Deactivation or Revocatoin
By Delly Parham, AS, CPC
Being revoked or deactivated as a Medicare provider can ruin your practice, and it’s up to you to assure you avoid it through revalidation.
Revalidation is the process through which a provider certifies the accuracy of his or her existing enrollment information with Medicare. Complying with revalidation requests within the specified time is necessary to avoid loss of billing privileges and disruption of Medicare reimbursements.
Revalidate when Requested
Medicare requires revalidation every five years, but Medicare also may perform off-cycle revalidations (including possible site visits). Off-cycle revalidations may be triggered by:
- Random checks
- Health care fraud problems
- National initiatives
- Complaints, or other reasons that cause the Centers for Medicare & Medicaid Services (CMS) to question the provider’s/supplier’s compliance with Medicare enrollment requirements
CMS is actively targeting the following types of providers for revalidation:
- Providers who are not registered in the Medicare Provider Enrollment, Chain, and Ownership System (PECOS)
- Providers who have not updated enrollment within the last five years
- Providers located in historically high-risk areas for Medicare fraud
- Providers who do not receive electronic funds transfer (EFT) payments
Do not submit a revalidation application unless specifically requested by Medicare. If you receive a request, you must respond within 60 days (see 42 Code of Federal Regulations (CFR), chapter IV, §424.515).
Medicare requires all changes to your practice to be reported within 30 or 90 days of the change to keep your enrollment information current. Make sure to report these changes within the specified time. To complete the revalidation application or to report a change, the provider or supplier may use either the Internet-based PECOS or a traditional paper application, completing the following:
- The applicable CMS-855 Enrollment Application form
- 855B: Medicare Enrollment Application for Clinics, Group Practices, and Certain Other Suppliers
- 855I: Medicare Enrollment Application for Physicians and Non-Physician Practitioners
- 855S: Medicare Enrollment Application for Durable Medical Equipment, Prosthetics; Orthotics, and Supplies (DMEPOS) Suppliers
- CMS-588 Electronic Funds Transfer Authorization Agreement form
- Certification and other supporting documentation requested by Medicare, such as a copy of IRS CP-575