All About Revalidation

I was walking by my coworker’s desk, and he turns to me with a client on the phone and says, “…the clinic doesn’t remember getting a letter from Medicare, but now Medicare is saying they will be deactivated. What should they do?”

Is this scenario familiar?  I hope not.

Not meeting the required credentialing due date will cause a disruption of reimbursement as Medicare will place a hold on your payments. If after 30 days of not receiving payments you still haven’t noticed that Medicare is knocking on your door, the next – and final – step Medicare will take is to deactivate your billing privileges. Yes, I said deactivate!

This will force you to complete the whole credentialing process, again. Depending on which MAC you are associated with, you are looking at 30-90 days of processing time.

Let that set in because that’s a long time to not get paid.

And then there are the therapists in your organization. Are they left to manage their own credentialing or is the busy front office personnel responsible?

So, what steps do you have in place to make sure none of this happens?

A Healthy Practice

A few simple steps to consider:

  • Centers for Medicare and Medicaid Services (CMS) has made the revalidation notification process a little easier with the Medicare Revalidation List. You can add your Organization NPI(s) to the proper field, click on the name of your Organization, and it opens to an extensive detail of the Providers within your Organization. This will give you a quick overview of not only the status of your group practice but also the Providers requiring revalidation and the due date.
  • Download the Revalidation List of your Organization as an Excel file and use it for notations.
  • Bookmark the Revalidation List link to your favorite browser.
  • Add a recurring reminder to your Outlook Calendar to revisit the CMS link and run another check on the Revalidation List. The CMS link refreshes close to every two months.
  • The revalidation notification will occur at the end of the month, on the same day and month of your last successful revalidation, so you just have to estimate the years. This happens every three years for DME suppliers and every five years for all other suppliers/providers.
  • Pay attention to what documents are required when the MAC requests for additional and/or missing information. If you are not sure, call.  Believe it or not, it is much easier to sit on the phone for 10-20 minutes then to supply the wrong documents and have to add another week or two to the process going back and forth with the provider enrollment department.
  • The fastest way to complete the revalidation process is to complete it online using PECOS. If you originally completed your 855 using a paper enrollment application, you can switch to PECOS for your revalidation process. Your MAC would have transferred your information to PECOS. *To use PECOS, you must get approved to access the system with the proper credentials which are obtained through the Identity and Access Management System, commonly referred to as “I&A”. Once you have established an I&A account you can then use PECOS to submit your revalidation application as well as other enrollment application submissions.

Follow the steps above to make sure you never miss your Medicare revalidation. Wanting more info on how stay compliant with Medicare? Download this strategy and preparedness tip sheet to help you learn how to monitor your own compliance and create a strategy plan around it.

Do you have any tips that I might’ve missed for prepping for your revalidation period? Let me know in the comments below!


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