Medicare Revalidation: It Begins Again

Medicare provider enrollment revalidation has entered phase two. The Centers for Medicare & Medicaid Services (CMS) has completed its initial round of revalidations under the Affordable Care Act (ACA) and will be resuming regular revalidation cycles — for physicians, that generally means revalidation every five years.

The ACA required all enrolled physicians, providers, and suppliers to revalidate their Medicare enrollment information under new enrollment screening criteria. Your new revalidation date will be based on your last successful revalidation date or enrollment, and generally will be on the last day of a month. Most likely this due date will remain with you throughout subsequent revalidation cycles.

Here are key points to remember:

  • Find your due date on CMS will post due dates six months in advance. A due date of “TBD” means CMS hasn’t set your date yet.
  • Novitas Solutions, the Medicare payer for Texas, will continue to send you a revalidation notice within two to three months before your due date, either by regular mail or email. However, TMA’s reimbursement specialists suggest you start the process as soon as CMS posts your due date, in case there are delays, and definitely no later than two months before your due date. 
  • Don’t try to revalidate before CMS posts your due date; your application will be rejected.
  • Submit a revalidation application online, where you can sign it electronically and upload your supporting documentation, or mail a signed paper certification statement with supporting documentation to Novitas.
  • When responding to revalidation requests, be sure to revalidate your entire Medicare enrollment record, including all reassignment and practice locations. If you have multiple reassignments/billing structures, you must coordinate the revalidation application submission with all parties. 
  • If your revalidation application is incomplete, Notivas will request the missing information and must receive it within 30 days, or Novitas will deactivate your billing privileges. 
  • If you don’t apply to revalidate by the due date, Notivas may place a hold on your Medicare payments and deactivate your Medicare billing privileges. You can reactivate them using your same Provider Transaction Access Number, but your billing privileges during the period of deactivation won’t be reinstated.

For more information from CMS, see:

Also visit TMA’s Medicare page for Medicare news, tips, and other resources.

Published March 28, 2017

TMA Practice E-Tips main page

Last Updated On

March 29, 2017

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