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Last chance for some providers to prevent deactivation by Medicare



August 04, 2016
Area(s) of Interest: Payor Contracting Payor Issues and Reimbursement Practice Management 

Noridian, Medicare’s administrative contractor for California, will soon begin deactivating billing privileges for physicians who received revalidation notices from Noridian but have not submitted completed applications to the Centers for Medicare and Medicaid Services (CMS). Last month, Noridian reported that only 19 percent of providers had responded to the most recent Medicare Part B revalidation notices. 


Since the passage of the Affordable Care Act (ACA), all Medicare providers and suppliers have been required to revalidate their Medicare enrollment information under new enrollment screening criteria in an effort to prevent fraud within the Medicare system. Once a Medicare enrollment application is validated, the clock starts ticking on a five-year revalidation cycle. Now that five years have passed since the ACA's revalidation requirement took effect, CMS has initiated a second cycle of revalidation requests.


Noridian will send revalidation notices two or three months prior to each provider’s revalidation due date.


The first revalidation due date for this second cycle was May 31, 2016. Effective August 14, 2016, Noridian will deactivate the Medicare billing privileges for affected physicians who failed to complete their revalidation applications CMS prior to the May deadline.


The due date for the second revalidation round was June 30, 2016. Noridian will deactivate billing privileges for physicians who missed the June deadline on September 13, 2016.


To prevent deactivation, the California Medical Association recommends that practices look up their revalidation dates through the CMS look-up tool. If it shows that your practice missed the deadline, you should submit and sign your application online through the PECOS system immediately to prevent deactivation


If you are ultimately deactivated for failure to respond to a revalidation notice, you will be required to submit a reactivation application. The date of receipt of the reactivation application will be the new effective date for your Medicare billing privileges. Noridian will not apply a retroactive effective date, and no payments will be made for the period of deactivation. If a revalidation application is received but incomplete, Noridian will contact you for the missing information. If the missing information is not received within 30 days of the request, Noridian will deactivate your billing privileges.


If your revalidation application is approved, no further action is needed


For more information on the revalidation process, see MLN Matters #SE1605. CMA is also hosting an upcoming webinar on this topic, Medicare Provider Enrollment: Strategies for Revalidation, Reporting Changes and Avoiding Deactivations, on Wednesday, August 17 from 12:15 to 1:15 p.m. This webinar will provide guidance on maneuvering the Medicare revalidation and enrollment process. Noridian experts will review how to avoid top errors and other key issues, including finding revalidation due dates, filling out the correct information on enrollment applications, responding to requests for additional information and keeping your enrollment record up to date. This webinar will also review new enrollment tools and tutorials.


If you have questions about the revalidation process, click here or contact Noridian at (855) 609-9960.

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