05.07.2018 | Client Alerts

Compliance Tips for Medicare Revalidation

CMS requires all Medicare-certified health care providers to revalidate their enrollment information every five (5) years (certain durable medical equipment suppliers must revalidate every three (3) years). Revalidation means that providers and suppliers must resubmit and recertify the accuracy of their enrollment information with their assigned Medicare Administrative Contractor (MAC).

CMS sets a due date for every provider’s revalidation application and provides notice of each provider’s due date on its website and through the provider’s MAC. When your revalidation application is due, CMS recommends that you file electronically through the Provider Enrollment, Chain and Ownership System (a/k/a PECOS). However, paper CMS-855 applications are accepted as well. The initial five year revalidation cycle has been completed. Providers certified after March 25, 2011 were excused from the initial cycle, but are participating in the second cycle, which is underway.

If you file your revalidation application after the due date, CMS may deactivate your Medicare billing privileges effective as of the due date.  Deactivation means Medicare will not process claims for services you provide after the revalidation application due date, and you will not be paid for any Medicare services that you deliver during the deactivation period. The deactivation period ends effective the date that you submit your late-filed revalidation application.

Here are five tips to help you get through the revalidation process:

1. Check the CMS website: https://data.cms.gov/revalidation, for your revalidation application due date. CMS posts due dates for Medicare Part A and Part B providers and suppliers about six (6) months in advance. If you see TBD (To Be Determined) instead of a date next to your name, then CMS has not yet set a due date for your application. Generally, applications will be due five (5) years after your initial revalidation due date if you participated in the first revalidation cycle. CMS reserves the right, however, to shorten the revalidation cycle for any provider. During the second cycle, the due date will always be the last day of the month in which the application is due.

The CMS website does not list due dates for durable medical equipment prosthetic orthotic suppliers (DMEPOS). Instead, the National Supplier Clearinghouse will send notices of revalidation due dates to those DME suppliers.

2. Keep your Medicare information up-to-date. CMS and your MAC will send notices of your upcoming revalidation application due date to the individuals and addresses that you have on file with your MAC.

Your MAC should send notice of the revalidation due date 60-90 days in advance of the date. Generally, CMS requires each MAC to adhere to the following protocol:

  • MAC will send a revalidation notice within two to three months prior to your revalidation due date either by email (to email addresses reported on your prior CMS filings) or regular mail (to at least two of your reported addresses: correspondence, special payments and/or your primary practice address) indicating the due date for your revalidation application.
  • The MAC will mail two revalidation letters. One to your special payments address and one to your correspondence address. If both of those addresses are the same, the second letter will be mailed to the your practice location address. If all three addresses are the same, only one letter will be mailed.
  • The MAC may also call the contact person or the Authorized Official on file with CMS.

You may not receive these notices or phone calls if your contact information on file with CMS is not current.

3. File your revalidation application by the due date listed on the CMS revalidation website, even if you have not received any notices from your MAC confirming the due date. Keep in mind that your MAC will not accept a revalidation application if a due date has not been set, or the application is filed more than six months in advance of the due date.

4. File as soon as possible after the due date if you miss the application deadline. Doing so will minimize your billing privilege deactivation period and associated loss of Medicare revenues. Your deactivation period will end effective as of the date you submit your late-filed application to the MAC. As stated above, CMS will not pay for Medicare services you provide during the deactivation period.

5. Consider filing a “rebuttal” statement with your MAC if CMS deactivates your billing privileges even though you complied with the revalidation filing requirements. The rebuttal should explain in detail the reasons why you believe you were in compliance. You should file the rebuttal as soon as possible after becoming aware that your billing privileges have been deactivated. The MAC will evaluate your statement, review its records, and send you a decision. A rebuttal is unlikely to succeed if you allege you did not receive any notices from the MAC, and the MAC demonstrates conclusively that it delivered one or more timely notices to you.

Filing of a rebuttal is the only avenue of appeal for a deactivation of billing privileges. You cannot appeal deactivation of billing privileges to an administrative law judge.

If you have any questions about this client alert, please contact Ruselle W. Robinson.

This Alert is provided for information purposes only, and does not constitute legal advice. According to Mass. SJC Rule 3:07, this material may be considered advertising. ©2018 Posternak Blankstein & Lund LLP. All rights reserved.

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