October 27, 2016

Section 6401 (a) of the Affordable Care Act established a requirement for all enrolled providers and suppliers to resubmit and recertify their Medicare enrollment information under new enrollment screening criteria. The Centers for Medicare and Medicaid Services (CMS) completed its initial round of revalidations (cycle 1) in March 2015 and in March 2016 resumed regular revalidation cycles (cycle 2) with several process improvements. Cycle 2 revalidation applies to those providers and suppliers that are currently and actively enrolled with Medicare.

CMS has established due dates by which a provider or supplier’s revalidation application must reach the Medicare Administrative Contractor (MAC) in order for them to remain in compliance with Medicare’s provider enrollment requirements. Due dates are posted on the CMS Medicare Revalidation Lookup Tool at http://go.cms.gov/MedicareRevalidation. The Medicare Revalidation List was last refreshed Sept. 1, 2016 (due dates March 01, 2016-March 31, 2017).

Reminder: If a provider or supplier fails to submit the revalidation application by the due date, or if the provider or supplier provides additional requested information after the due date (including an allotted time period for US or other mail receipt), the provider enrollment record will be deactivated. Deactivated providers and suppliers will be required to submit a full and complete application in order to reestablish their provider enrollment record and related Medicare billing privileges. An interruption in billing will occur during the period of deactivation resulting in a gap in coverage.  Retroactive billing privileges back to the period of deactivation will not be granted.  Services provided to Medicare beneficiaries during the period between deactivation and reactivation are the provider’s liability.

Any questions or concerns regarding this educational letter should be directed to Andrea King, Novitas Provider Outreach and Education, at andrea.king@novitas-solutions.com or 717 | 526-6392.

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