Tracking Medicare Revalidation is Vital to Practice Revenues

Tracking Medicare Revalidation is Vital to Practice Revenues - PracticeForces

Tracking Medicare Revalidation is Vital to Practice Revenues


Covid-19 has had us stretched in all directions, but amidst the change, have you checked if your medical practice providers are due for a Medicare revalidation? Medicare revalidations are on hold during the pandemic, but revalidation deadlines can be active soon.


Why do you need a Medicare revalidation? 


Medicare revalidations are done for all providers (solo and group practices) to verify the provider addresses as legitimate practice locations. The aim is to check for fake healthcare providers who are processing claims for non-existent patients/ medical services. It is why the Medicare revalidation process can also require an on-site visit by a Medicare inspector. Medicare revalidation is under the Patient Protection and Affordable Care Act (Section 6401).


If a provider has been with your practice for a couple of years, they may well be due for a Medicare revalidation. That’s because Medicare revalidates the credentials of a medical provider at least once in five years. In some cases, Medicare can conduct off-cycle revalidation if deemed necessary for program integrity purposes.


Typically, the Medicare revalidation notice is sent three to four months before the due date. The information is sent by email or by the U.S. postal service to the address of the medical provider listed in the PECOS (Provider Enrolment Chain and Ownership System).


If a provider was previously employed with another practice and has not submitted a change of address application, the Medicare notification may have been missed. To check if any of the providers in your medical practice are due for a Medicare revalidation, use the online tool ‘Medicare Revalidation List.’


The Medicare revalidation process


You have two options for sending the Medicare revalidation application. The first is to submit the information via the PECOS. You may have to make an online payment as an application processing fee. The other way is to submit the CMS-855 paper enrolment application.


As the owner of a solo medical practice, you must submit Medicare revalidation applications as an ‘individual’ as well as ‘an entity.’ As a registered user on PECOS, you should be able to access both records. If both forms are not visible, you can request access through the PECOS Identity and Access Management (I&A) system.


If you have not received a Medicare notice but are within three months of the due date, you can initiate the revalidation process. As per CMS, Medicare revalidation applications received before seven months of the due date will be returned as unsolicited.


Post the submission of the revalidation application and supporting documents, the process can take about 60 days. If revalidation requires an on-site visit, it can take 90 days or more.


Consequences of missing your Medicare revalidation date


Missing your Medicare revalidation due date will result in the suspension of Medicare payments and possibly the loss of your Medicare billing privileges. Once the Medicare Provider Transaction Access Number (PTAN) is deactivated, you lose the right to claim any payments for services rendered. No claims are paid retroactively even after Medicare revalidation. So, if you do receive a revalidation notice, take immediate action.


If you use our billing services, please connect with us right away for any assistance with medical credentialing and completing the Medicare revalidation application.

Parul Garg, CEO and co-founder of PracticeForces, has significantly contributed to the growth of over 1,000 U.S. medical practices through her expertise in medical billing and coding since the company’s inception in 2003. With a background in Computer Science and an MBA in Human Resources, her leadership and AAPC-certified coding skills have been pivotal in managing the company’s operations effectively.

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