Revalidating medicare enrollment

Those physicians who have been enrolled with the Missouri Medicaid program the longest will be the first to receive revalidation packets.

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Revalidating providers are required to complete specific paper forms and they must be submitted to MMAC directly by e-mail, fax, or regular mail.Providers and suppliers who have not yet revalidated will be well-served by advance preparation by gathering the information needed to complete in full the appropriate Medicare enrollment forms.The quick response time required to assemble a full Medicare application after receiving a MAC request will be challenging for most respondents.The revalidation effort is called for under the Patient Protection and Affordable Care Act (“PPACA”), which requires that all providers and suppliers that have enrolled prior to March 25, 2011 revalidate under new program integrity rules that went into effect on that date.Revalidation requirements are nothing new; law in existence prior to the passage of PPACA required all providers and suppliers to revalidate every five years (three years for durable medical equipment, prosthetics, orthotics and supplies (“DMEPOS”) suppliers), However, providers and suppliers irregularly received requests to revalidate their enrollment files.MMAC anticipates having an electronic portal for revalidations available in late 2015 or early 2016 Effective July 1, 2015, MMAC will begin revalidating all currently enrolled MO Health Net providers.During the next two state fiscal years, MMAC will be concentrating on revalidating the approximately 20,000 currently enrolled physicians (MD and DO).Federal regulation 42 CFR Section 455.414 requires providers to revalidate their enrollment with the New York State Medicaid Program.Providers have already received written reminders to revalidate, though some providers have not done so.Diligence on the front-end can help avoid a costly and disruptive enrollment deactivation. An enrollment revocation with a subsequent term-limited enrollment ban is also possible, but CMS has indicated on several occasions that this enrollment revalidation effort will not result in revocations.CMS, Further Details on the Revalidation of Provider Enrollment Information, MLNMatters SE1126, Revised August 10 and December 9, 2011,available at https://gov/MLNMatters Articles/downloads/SE1126.; CMS, Important Information on Revalidation of Provider Enrollment, email to [email protected] See MLN Matters SE 1126 and Transcript of CMS Revalidation of Medicare Provider Enrollment National Provider Call, October 27, 2011, available at this link.

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