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

These forms may be found here. For information on how to do this, go to the CMS website. Call your local carrier if you have questions or need instruction.

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5 Responses to “Save Your Practice. Avoid Medicare Deactivation or Revocatoin”

  1. Jennifer M says:

    While I agree with the requirements, I think the charges are ridiculous! For large practices, the fees must seem astronomical! This is a government entity that we pay for with our tax dollars, we should not have to pay again to register to do the required paperwork for that entity. It is almost like double jeopardy.

  2. Victor says:

    I thought recertification is mandatory every five years?

  3. Pat says:

    CP575 is only provided once by the IRS the replacement
    is 147C will Medicare accept the substitute

  4. Tammy says:

    My company is dealing with this situation right now for one of its doctors. Somehow the request was over looked and the doctors billing was affected from Nov. until April. It has cost lots of money in claims, man hours, and legal fees not to mention how many times the paperwork was returned because people did not follow the instructions to the letter. I must say-the process is definitely the typical government process: red tape, loop holes and wasted time and money. I feel for anyone who gets caught in this nasty web!

  5. Donna Smith says:

    In our experience, yes, CMS accepts the 147C from the IRS

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