Center for Medicare and Medicaid Services (CMS) is requiring that all providers and suppliers enrolled with Medicare prior to March 25, 2011, must revalidate their enrollment information. Basically, all providers (home health agencies included) that bill Medicare for services provided must enroll by March 23, 2013.
Section 6401 (a) of the Affordable Care Act established a requirement for all enrolled providers and suppliers to revalidate their enrollment information under new enrollment screening criteria. This revalidation effort applies to those providers and suppliers that were enrolled prior to March 25, 2011. Newly enrolled providers and suppliers that submitted their enrollment applications to CMS on or after March 25, 2011, are not impacted. They will be screened under the new guidelines anyway. Between now and March 23, 2013, MACs (Medicare Administrative Contractors like Palmetto, Cigna, NGS, Anthem) will send out notices on a regular basis to begin the revalidation process
Providers and suppliers must wait to submit the revalidation only after being asked by their MAC to do so. Upon receipt of the revalidation request, providers and suppliers have 60 days from the date of the letter to submit complete enrollment forms. Failure to submit the enrollment forms as requested may result in the deactivation of your Medicare billing privileges.
Screening Processes
Beginning on March 25, 2011, Medicare began placing newly-enrolling and existing providers and suppliers in one of three levels of categorical screening: limited, moderate, or high. The risk levels denote the level of the contractor’s screening of the provider or supplier when it initially enrolls in Medicare, adds a new practice location, or revalidates its enrollment information.
Chapter 15, Section 19.2.1 of the “Program Integrity Manual” (PIM) provides the complete list of these three screening categories, and the provider types assigned to each category, and a description of the screening processes applicable to the three categories (effective on and after March 25, 2011), and procedures to be used for each category. Once again, that new section of the PIM is attached to CR7350.
Although fingerprinting and criminal background checks are included in CMS-6028-FC as requirements for providers and suppliers in the “high” category of screening, these requirements will be implemented at a later date and providers and suppliers will be notified well in advance of their implementation.
What You Need to Do
When you receive notification from your MAC to revalidate:
- Update your enrollment through Internet-based Provider Enrollment, Chain and Ownership System (PECOS) or complete the 855;
- Sign the certification statement on the application;
- If applicable, pay your fee thru pay.gov; and
- Mail your supporting documents and certification statement to your MAC.
The most efficient way to submit your revalidation information is by using the Internet-based PECOS.
To revalidate via the Internet-based PECOS, go to https://pecos.cms.hhs.gov on the CMS website. PECOS allows you to review information currently on file, update and submit your revalidation via the Internet. Once submitted, YOU MUST print, sign, date, and mail the certification statement along with all required supporting documentation to the appropriate MAC IMMEDIATELY.
Section 6401(a) of the Affordable Care Act also requires the Secretary to impose a fee on each “institutional provider of medical or other items or services and suppliers. Upon receipt of the revalidation request, providers and suppliers have 60 days from the date of the letter to submit complete enrollment forms. Failure to submit the enrollment forms as requested may result in the deactivation of your Medicare billing privileges.
To learn more about this new rule, visit:
http://www.cms.gov/MLNMattersArticles/downloads/SE1126.pdf
