By Delly E. Parham, AS, CPC
When Medicare requests your provider to certify the accuracy of his or her existing enrollment information with Medicare revalidation, comply in a timely manner. If you don’t, you may lose Medicare billing privileges or disrupt reimbursement.
Revalidate when Requested
Medicare requires revalidation every five years, but also may perform “off cycle” revalidations (including possible site visits). Off cycle revalidations may be triggered by:
- Random checks
- Health care fraud problems
- National initiatives
- Complaints, or other reasons that cause CMS to question the provider’s/supplier’s compliance with Medicare enrollment requirements
- CMS is actively targeting the following types of providers for revalidation:
- Providers who are not registered in the Medicare Provider Enrollment, Chain, and Ownership System (PECOS)
- Providers who have not updated their enrollment within the last five years
- Providers located in historically high-risk areas for Medicare fraud
- Providers who do not receive electronic funds transfer (EFT) payments
Note: Do not submit a revalidation application unless a Medicare contractor contacts you. Upon receipt of the notification, you must respond within 60 days of the request (see 42 Code of Federal Regulations (CFR), chapter IV, §424.515: ).
Certain Changes Require Revalidation
Certain enrollment information changes, such as a change in practice location or a change in the “special payments and correspondence” address on file with Medicare, may affect timely compliance with revalidation requests. Medicare sends its revalidation letters and other correspondence to the “special payment and correspondence address” on file with Medicare. If a correspondence is returned to Medicare marked “undeliverable,” or if a provider does not respond to Medicare’s request within the time specified in the notice, the provider’s billing privileges will be deactivated or revoked.
Prevent or Minimize Deactivation or Revocation
Medicare requires that all changes to your practice be reported within 30 or 90 days of the change to keep your enrollment information current. Make sure to report these changes within the specified time.
To complete the revalidation application or to report a change, the provider or supplier may either use the Internet-based PECOS or a traditional paper application. Regardless of which method is used, the provider must complete the following:
- The applicable CMS-855 Enrollment Application form:
- 855B: Medicare Enrollment Application for Clinics, Group Practices, and Certain Other Suppliers;
- 855I: Medicare Enrollment Application for Physicians and Non-Physician Practitioners
- 855S: Medicare Enrollment Application for Durable Medical Equipment, Prosthetics; Orthotics, and Supplies (DMEPOS) Suppliers
- CMS-588 Electronic Funds Transfer Authorization Agreement form
- Certification and other supporting documentation requested by Medicare, such as a copy of IRS CP-575
These forms may be found on the CMS website.
Medicare Part B Update reported that 90 percent of applications and changes of information submitted through PECOS are processed within 45 days of receipt of the signed and dated Certification Statement, versus 80 percent during the same time for paper applications. Processing times may depend on the Medicare administrative contractor (MAC) in your geographic region (depending on the changes made to the application, processing can take over six months). To use PECOS, you must have your organization or individual National Provider Identifier (NPI).
If you use PECOS to make any changes, complete enrollment revalidation, or report a change, and find that you need assistance with your user ID or password, you may contact the help desk using the CMS website or by calling 1-800-465-3203.
January 14th, 2013
Based on provider feedback, the Centers for Medicare & Medicaid Services (CMS) has made several upgrades to the Provider Enrollment, Chain, and Ownership System (PECOS) to increase access to more information.
The following upgrades are now available:
- Providers/suppliers can now submit their entire enrollment application including supporting documentation electronically with the new digital document feature. For more information, see the “Digital Documents Repository How to Guide” on the CMS website.
- Individual providers who reassign benefits to individuals/organizations with multiple practice locations can designate a primary and secondary practice location where services are rendered. This is recommended, but not required.
- Providers/suppliers are now able to enter multiple contact persons in the Contact Information section and identify the contact’s relationship to the provider/supplier.
- At least one managing employee will now be required when submitting a CMS 855A, CMS 855B, and CMS 855S enrollment application. Applications that do not include at least one managing employee will receive an error message in Internet-based PECOS under the Error/Warning Check tab and will not be able to proceed with submitting the enrollment application. Internet-based PECOS will also recommend that at least one owner is entered for a CMS 855A, CMS 855B and CMS 855S application. Applications that do not include at least one owner will receive a warning message under the Error/Warning Check tab in Internet-based PECOS. This warning message will not prevent the user from submitting the enrollment application.
- Providers/suppliers now have the option to select “County” in the “Geographic Location” topic when identifying the geographic location where services are rendered for CMS 855A and CMS 855B enrollment applications.
- The CMS 855O paper application, used to enroll in Medicare solely to order and refer services, has been redesigned; those changes are now reflected in Internet-based PECOS.
To access the internet-based PECOS, go to the PECOS website.
September 12th, 2012
Any latency and performance issues you may have experienced with the National Plan and Provider Enumeration System (NPPES) have been resolved, according to the Centers for Medicare & Medicaid Services (CMS). The National Provider Identifier (NPI) registry is fully operational again.
June 18th, 2012
The Centers for Medicare & Medicaid Services (CMS) announced a new data and information initiative it says will be a key tool in the agency’s evolution from a fee-for-service based payer to a value-based purchaser of care. A new Office of Information Products and Data Analytics (OIPDA) will oversee CMS’ portfolio of data and information and make it more accessible to health care professionals and patients. Under OIPDA, the development, management, use, and dissemination of data and information resources will become one of CMS’ core functions. CMS says the agency and its partners will be better able to define and reward high quality, low cost care.
Signing up on the authenticated Internet-based Medicare Provider Enrollment, Chain, and Ownership System (PECOS) just got a little easier for providers and their staff. The Centers for Medicare & Medicaid Services (CMS) has issued a new rule that allows the authorized official (AO) or the delegated official (DO) of an organization to electronically sign the enrollment application. (more…)