The Centers for Medicare & Medicaid Services (CMS) Division of Enrollment Operations is beginning Cycle 2 of the provider and supplier revalidation process, as required under Section 6401(a) of the Affordable Care Act. CMS has completed its initial round of revalidations and will begin regular revalidation cycles in accordance with 42 C.F.R. § 424.515. All Medicare enrolled providers and suppliers are required to resubmit and recertify the accuracy of enrollment information every five years (durable medical equipment suppliers must revalidate every three years). In an effort to streamline the revalidation process, CMS has implemented several improvements. The following is a list of items that providers and suppliers should know about Cycle 2 revalidations:
- Due Dates: Due dates will be posted on the CMS website, which includes a provider and supplier look up feature (available here). Due dates will fall on the last day of a month and will typically remain the same for subsequent revalidation cycles. Providers and suppliers that are not yet due for revalidation will display a “TBD” in the due date field.
- Revalidation Notices: The Medicare Administrative Contractor (MAC) will send a revalidation notice within 2-3 months prior to the revalidation due date, either by email or regular mail. Emails will be sent to email addresses reported on previous applications and will include “URGENT: Medicare Provider Enrollment Revalidation Request” in the subject line. Notices sent by mail will be sent to at least two of the reported addresses: correspondence, special payments, and/or the primary practice address. Providers and suppliers that are within two months of their listed due dates, but have not received a notice to revalidate, should submit their revalidation applications.
- Deactivation of Billing Privileges: Providers and suppliers should respond timely to requests from their MAC. If billing privileges are deactivated as a result of the provider or supplier’s failure to respond to such requests, reactivation will only be retroactive to the date of submission of a subsequently approved new enrollment application and not to the deactivation date, which will result in a gap in payment. If deactivation occurs, the provider or supplier will maintain their original PTAN.
- Unsolicited Revalidations: CMS will return unsolicited revalidation applications that are submitted more than six months in advance of the due date, or when a due date is not yet listed on the CMS website.
- Providers and Suppliers Included: Providers and suppliers that are enrolled solely to order, certify, and/or prescribe via the CMS-855O application, or who have opted out of Medicare, will not be asked to revalidate and will not be included in the provider lookup tool.
- Application Fee: All institutional providers (all providers except physicians, non-physicians practitioners, physician group practices and non-physician practitioner group practices) and suppliers that respond to a revalidation request must submit the enrollment fee, which is $554.00 for Calendar Year 2016.
For more information about Cycle 2 revalidation, please click here.
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