Part B Insider (Multispecialty) Coding Alert

Physician Notes:

Know the Facts on Medicare Provider Enrollment and Revalidations

Published on Mon Sep 19, 2022

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As the healthcare industry continues to reinstate policies as COVID cases ebb and flow, you may have forgotten that revalidations were reinstated for 2022. But, be warned — ignoring this critical provider enrollment requirement could cause your Medicare payments to be put on hold.

Read on for the latest update.

Details: After a COVID-inspired pause, the Centers for Medicare & Medicaid Services (CMS) resumed Medicare provider enrollment revalidations on Jan. 31, 2022. But some providers haven’t begun the process while others may not have been assigned a revalidation due date and now risk deactivation from the Medicare program, warns Part A/B Medicare Administrative Contractor (MAC) NGS Medicare in an Aug. 23 alert.

“If a 2022 revalidation due date has not been assigned or if the due date is TBD, all unsolicited revalidation applications will be returned,” NGS cautions. That’s why it’s critical that you utilize either your MAC’s online revalidation tools or check your mail for the traditional revalidation letter that comes in a yellow envelope from CMS.

Reminder: Providers should “revalidate Medicare enrollment information either electronically by using the Internet Based Provider Enrollment, Chain and Ownership System (PECOS) or by submitting the appropriate CMS-855 paper application” through the mail, the Part B MAC instructs.

According to NGS, other important revalidation steps to remember include:

Pay your revalidation fees.
Sign and date the necessary forms.
Ensure all documents, certifications, and credentials are included with your paperwork.
Verify that the provider and/or practice legal name matches federal and tax documents.

Don’t forget: Your status may be approved, but you may need to follow up with credentialing agencies in your state, NGS advises. “If status is ‘Approval Recommendation,’ you will need to contact the state agency indicated in your approval recommendation letter.”

Resource: Check with your individual MAC for jurisdictional requirements and find CMS’ tools on revalidation at www. cms.gov/Medicare/Provider-Enrollment-and-Certification/ Revalidations.