All Medicare providers/suppliers are required to resubmit and recertify the accuracy of enrollment information every 5 years (3 years for DME suppliers). Cycle 2 of the Medicare Provider Enrollment Revalidation process is currently under way. It is important to respond in a timely manner to revalidation notices.

Your Medicare Administrative Contractor (MAC) will issue revalidation notices within 2-3 months of your established due date. Failure to submit by the due date could result in a hold on your Medicare payments and possible deactivation of your Medicare billing privileges. If you submit after a payment hold takes effect, it is not a fast or easy process to get payments resumed. Deactivated providers/suppliers are required to submit a complete enrollment application to be reactivated. The provider/supplier will maintain their original PTAN, but will not be paid for services rendered during the period of deactivation, resulting in a gap in reimbursement. The reactivation date is based on the receipt date of the new application. You cannot retroactively bill for services provided while you were deactivated.

CMS publishes a list of Medicare revalidation due dates 6 months in advance. We are notifying all of our clients with the following provider types if they have an upcoming due date. Here is a breakdown of status by provider type:

Provider Type Completed Due in Next 6 Months Due Date To Be Determined
Skilled Nursing Facility 20% 3% 77%
Home Health Agency 0% 0% 100%
Hospice 27% 0% 73%
Critical Access Hospital 15% 0% 85%
Hospital (incl. LTACH) 18% 5% 77%
Rural Health Clinic 9% 0% 91%
Outpatient Therapy 12% 67% 20%
Federally Qualified Health Center 0% 0% 100%

 

The Medicare provider enrollment revalidation effort does not change other aspects of the enrollment process. Providers should continue to submit routine changes (address updates, reassignments, additions to practices, changes in authorized officials, information updates) as they always have.

More details are available on the CMS Revalidation web page. Please contact an HW Healthcare Advisor if you have questions or want to know if your revalidation due date is within the next six months.