Medicare Enrollment Revalidation Services

With the passing of the Patient Protection and Affordable Care Act (PPACA) in 2010, Medicare was mandated to conduct off-cycle Medicare enrollment revalidation. Medicare was mandated to do this in the continued effort to try to curb Medicare fraud. The revalidation applies to all Medicare providers who enrolled in Medicare prior to 3/25/11. This mandate applies to more than 1.4 million existing Medicare providers and will require those providers to revalidate their Medicare enrollment under the new screening requirements that went into effect on and after 3/25/11. So if you were enrolled as a Medicare provider after 3/25/11, you have already been through this process, and, any provider who is enrolling now as a new Medicare provider will also go through this process. Medicare’s main goal in all this is to insure that only legitimate providers remain in the Medicare Fee for Service (FFS) program.

FIRM SERVICES revalidate_medicare_enrollmentFor review, the PPACA established screening criteria for all providers who apply for enrollment with the Medicare FFS program on and after 3/25/11 according to risk of fraud and abuse. These risk categories are:

Limited Risk: This category includes:

 -Physician and non-physician providers except physical therapists
-Non-physician group practices except physical therapy group practices

Moderate Risk: This category includes:

-Physical Therapists enrolling as individuals and group practices
-Re-validating DMEPOS suppliers

High Risk: This category includes:

Due to Medicare finding “store front fraud shops”, Medicare is calling to determine that someone actually answers the phone number during the listed business hours and then make an onsite visit to determine that the clinic is actually at the address on the application and open during the listed business hours, is staffed, has equipment, and looks like physical therapy is being provided to patients. So far, the MAC representatives have not asked to see any records. To be honest, they probably don’t have time considering the number of clinics that need to be visited.

For all medical offices that are subject to the revalidation process, it will work the same as above, EXCEPT, you will receive a letter from Medicare requiring you to revalidate the information on the original application. You will have 60 days from the receipt of the letter to submit the information for revalidation. Don’t be late!

Click here and review a sample Revalidation letter request.

Medicare has de-activated 23,000 providers so far who were late turning in the required information. No, you cannot send in your information before it is requested.

So what to do?

Contact us immediately at the Firm Services to complete your mandatory PPACA Revalidation for large multi-specialty groups or individual practitioners. You can reach The Firm’s Revalidation & Credentialing experts for assistance at (512) 243-6844 today!

Medicare expects to complete the revalidation process by 2015. In addition to this validation/re-validation process, you should know that CMS has the authority to adjust the risk rating of a particular provider and the Secretary of Health and Human Services has the authority to impose a geographic enrollment moratorium at the Secretary’s discretion.