Between now and March 23, 2013, providers and suppliers (providers) who enrolled in Medicare prior to March 25, 2011 will have to revalidate their enrollment information under the new enrollment screening criteria required by Section 6401(a) of the Affordable Care Act.  Providers should not begin revalidation, however, until receiving notification to revalidate from their Medicare Administrative Contractor.  Providers who enrolled after March 25, 2011 have already been subject to the new screening requirements and, thus, do not have to revalidate at this time.  CMS recently released a Medicare Learning Network article to explain the revalidation process.

CMS published the new enrollment screening criteria on February 2, 2011 as a final rule with comment period.  The final rule categorizes providers as either limited, moderate or high risk and then applies various screening tools, such as license verification, database checks and unannounced site visits, based on the provider’s associated level of risk.  Additionally, unless qualifying for a hardship exception, institutional providers must pay an application fee ($505 for calendar year 2011, to be adjusted in subsequent years by the CPI-U).

Upon receipt of notification to revalidate, providers should:

  • update enrollment through the internet-based PECOS or complete the paper 855;
  • sign the certification statement on the application;
  • pay the applicable fee through and print out a copy of the payment receipt;
  • immediately mail supporting documents, the certification statement and the payment receipt to the MAC.

Providers have 60 days upon receipt of the revalidation request to submit complete enrollment forms.  Failure to do so may result in deactivation of the provider’s billing privileges.