CMS Begins Medicare Revalidation Process for Providers

The Centers for Medicare & Medicaid Services (CMS) has begun the process of revalidating DME providers who enrolled in the Medicare program before March 25, 2011.

In a bulletin sent out last week, CMS said revalidation was the result of "new risk-screening criteria required by the Affordable Care Act," which was signed into law by President Obama on March 23, 2010. DME providers who registered with Medicare on or after March 25, 2011, do not need to undergo revalidation because they "have already been subject to this screening."

CMS added that the revalidation process is a "continued effort to reduce fraud, waste and abuse."

According to CMS, providers being revalidated will be assigned to one of three screening categories - limited, moderate or high - "each representing the level of risk to the Medicare program for the particular category of provider/supplier."

The Medicare Administrative Contractor (MAC) that will perform the revalidation will use the screening category to determine the degree of screening.

The MACs will be sending out revalidation notices to providers from now until March 2013, but the bulletin said, "Please begin the revalidation process as soon as you hear from your MAC. Upon receipt of the revalidation request, providers and suppliers have 60 days from the date of the letter to submit complete enrollment forms."

Providers who do not submit the enrollment forms as required may have their Medicare billing privileges canceled, CMS stated. The bulletin encouraged providers to use the Internet-based Provider Enrollment, Chain and Ownership System (PECOS) to revalidate enrollment information. PECOS can be accessed at https://pecos.CMS.hhs.gov.

CMS has also created a Medicare Learning Network article, number SE1126, with details on the revalidation process. Click HERE to download the article.

About the Author

Laurie Watanabe is the editor of Mobility Management. She can be reached at lwatanabe@1105media.com.

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