Physicians who enrolled with Medicare prior to March 25, 2011, must revalidate their enrollment information but only after receiving notification from TrailBlazer, the Medicare administrative contractor for Texas.
Typically, Medicare requires providers to revalidate enrollment information every five years. But the Affordable Care Act requires all providers and suppliers enrolled prior to March 25, 2011, to revalidate their enrollment information under new enrollment screening criteria.
Between now and March 23, 2013, TrailBlazer will send out notices on a regular basis to begin the revalidation process for each provider and supplier within its jurisdiction. Don’t do anything until you receive your revalidation request.
When you receive notification to revalidate from TrailBlazer:
- You must furnish the necessary information within 60 calendar days of the request. If you don’t, Medicare can s inactivate your enrollment and suspend your payments.
- Complete your reenrollment carefully. Even differences in authorized signatures can trigger delays.
- Update your enrollment online through Medicare’s Provider Enrollment, Chain and Ownership System (PECOS), or complete the CMS-855 paper enrollment form. PECOS allows you to review information currently on file, update, and submit your revalidation via the Internet.
- Print, sign (in blue ink), and date the certification statement on the application.
- If you are enrolling as a durable medical equipment, prosthetics, orthotics, and supplies (DMEPOS) provider via the CMS-855S application, pay a $505 application fee through www.pay.gov. Mail the certification statement and your supporting documents (including a copy of your receipt if you paid the DMEPOS fee) to TrailBlazer immediately.
Reminder: Revalidation doesn’t affect routine enrollment processes — continue to submit changes. You must report changes of ownership or control, a change in practice location, or final adverse action* within 30 days of the reportable event. Submit all other changes within 90 days of the reportable event.
For more information:
- See the Centers for Medicare & Medicaid Services’ MLNMatters No. SE1126 and No. SE1130 (PDF).
- Attend TMA’s annual don’t-miss Medicare update seminar. Physicians and staff need to understand the ever-more-complicated Medicare system to ensure your practice can get paid accurately, benefit from incentives, and avoid allegations of fraud and abuse. Revalidation is one of many important topics covered in this information-packed, half-day seminar. Register now to attend “Medicare 2012” in a city near you.
*A final adverse action includes: (1) a Medicare-imposed revocation of any Medicare billing privileges; (2) suspension or revocation of a license to provide health care by any state licensing authority; (3) revocation or suspension by an accreditation organization; (4) a conviction of a federal or state felony offense (as defined in 42 CFR 424.535(a)(3)(A)(i)) within the last 10 years preceding enrollment, revalidation, or reenrollment; or (5) an exclusion or debarment from participation in a federal or state health care program.
Published Oct. 24, 2011
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