Practice Management Alert

Prepare to be dropped if you don't have a handle on the rules When's the last time you revalidated your providers- CMS-855 form? If you haven't done it within the past five years or if your provider's information changed, you-d better get busy. Now is the time to ensure you understand Medicare's revalidation process -- because if you-re slacking, your Medicare carrier can retract your billing privileges. Don't Invite Scrutiny -- Know When to Revalidate Background: In the April 21, 2006, Federal Register, CMS instructed all Medicare providers to revalidate their Medicare information on file, via a CMS-855 form, within 60 days of receiving a written revalidation request from their CMS fiscal intermediary or carrier, says Lyndean Brick, JD, senior vice president of Murer Consultants Inc. in Joliet, Ill. While that sounds simple enough, many providers have never filed a complete CMS-855, which can make the revalidation process quite difficult, Brick says. And you may even receive an on-site survey if CMS discovers enough discrepancies. There's more: "Generally speaking, once a provider submits a complete CMS-855, either in response to a revalidation request or otherwise, the provider must then revalidate his entire CMS-855 filing once every five years -- or within 90 days after any change in his Medicare provider information," Brick says. Be Consistent, Especially Now That NPI Is Here If you-re not sure what kind of information you need to have for CMS for revalidation, check out a copy of the Medicare enrollment form at http://www.cms.hhs.gov/cmsforms/downloads/cms855i.pdf. You-ll notice that the agency requires a slew of information ranging from your practice name to your licensure status. You may find that pieces of this required information are out of date for your practice or facility, so it's time to fix that fast and submit a fresh 855 form to CMS. Important: As you update your information, consider consistency a top priority. Why? "One of the biggest problem areas we find is that providers aren't consistent with names, among other things, in their legal documentation," Brick says. For example, a practice may have opened with the name Spring Valley Medical Center, but it bills as Spring Valley Family Practice, and its information on file with CMS may say Spring Valley Family Medi-cine. And CMS won't go for that. Critical: Now, with NPIs going into full swing, the practice or facility name and other information you-ve filed on your NPI application must match your legal docu-mentation. "Even if one little thing gets out of whack and CMS catches it, its contractors can stop reimbursement," Brick says, "even something as small as your IRS information not matching your NPI information." Note: "When the NPPES [National Plan and Provider Enumeration System] information doesn't [...]