February 04, 2014
Area(s) of Interest: Advocacy Commercial Payors Health Care Reform Payor Issues and Reimbursement
As called for under the Affordable Care Act (ACA), Medicare Administrative Contractors (MACs) have been requiring physicians to revalidate their Medicare enrollments. Between now and March 23, 2015, MACs will continue reaching out to physicians, notifying them of the need to revalidate. The most recent round of revalidations requests went out by December 30, 2013.
The revalidation requirement is necessitated by new screening criteria called for under the ACA. Newly enrolling and revalidating providers will be placed in one of three screening categories representing the level of risk to the Medicare program. The level of risk will determine the degree of screening to be performed when processing the enrollment application.
Physicians who receive a request for revalidation must respond to that request within 60 days or face the possibility of being deactivated. Do not do anything until you get a letter instructing you to revalidate. (This is very important to ensure an orderly enrollment process.) Physicians who are making changes (moving, closing practice, etc.) should continue to submit their changes as usual.
For providers in PECOS – the revalidation letter will be sent to the special payments and correspondence addresses simultaneously. If these are the same, it will also be mailed to the primary practice address.
For providers NOT in PECOS – revalidation letters were sent earlier this year to the special payments or primary practice address. If you are not in PECOS and have not already received a letter, contact Noridian for guidance.
To find out whether you have been mailed a revalidation notice go to the revalidation page on the Centers for Medicare and Medicaid Services website. If you are listed, and have not received the request, contact Noridian at (855) 609-9960.
Contact: CMA reimbursement help line, (888) 401-5911 or firstname.lastname@example.org.