Don’t Hesitate — Revalidate

Revalidation efforts are underway again, but this time for all providers and suppliers. When CMS revised the Medicare enrollment rules in June 2006, one change was to require each provider or supplier to revalidate its enrollment at least every 5 years. The initial revalidation efforts, which began in 2007, focused on providers and suppliers that had enrolled prior to 2003, when CMS had fully implemented the PECOS database for maintaining Medicare enrollment data. This article contains information on the revalidation process and tips for preparing revalidation forms.

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Application Fees

To help offset the costs of the screening required under the program safeguard rules for Medicare-enrolled providers and suppliers, an application fee was implemented.   With the annual update factor, the current fee for $505.00 for 2011 and $523.00 for 2012.

Application fees are assessed at the time of the initial Medicare enrollment, when a practice location is added, and when responding to a revalidation request.  With the exception of individuals (physicians and non-physicians practitioners) and group practices, all other providers and suppliers are assessed the application fee.

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New Medicare and Medicaid Enrollment Rules Take Effect Today

Significant changes effecting Medicare- and Medicaid-enrolled providers and suppliers take effect today, March 25, 2011.  The new regulations are in response to provisions in the recent health care reform legislation designed to enhance the enrollment procedures to protect against fraud.  All Medicare-enrolled providers and suppliers were grouped into one of three categories “limited,” “moderate,” or “high” risk, with delineated enrollment screening procedures for each category.  The greater the perceived risk of fraud, the more scrutiny for the applicant or enrollee.

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