Medicare requires a revalidation of certification every five years, and DME suppliers must revalidate every 3 years. This is part of CMS’s provider screening process and is intended to help reduce fraud and abuse. Other payers have quickly begun jumping on this bandwagon. Missing a revalidation is not only a headache, it can also cause a pause in your ability to receive payment from the payers.
SMB does not specialize in contracting or credentialing, but we want to provide you with the most up-to-date information to eliminate problems with your revalidations. In this article, we will discuss the process for Medicare. Keep in mind that many Medicaid programs and also a few commercial payers are also following the same, or similar, process.
- Medicare due dates will always be on the final day of the month, and providers can submit their revalidation up to six months in advance.
- Providers will be notified of their due date by their prospective Medicare Administrative Contractor 2-3 months prior to the due date. These are sent by email. If no email address has been provided, it will be sent by postal mail.
- Providers can also use the Medicare revalidation tool found at Data.CMS.gov/revalidation to find any approaching due dates for providers or DME. To use the tool, put your NPI in the space provided and leave all other spaces blank. If you find a TBD, you have not yet been assigned a revalidation date. This is updated every 3 months for convenience and shows dates up to 6 months out.
If you happen to miss a revalidation, your claims will not be accepted by the payer. At this point, you only have a very short period of time to get your application submitted. Failure to meet this deadline can result in deactivation of Medicare billing privileges, resulting in no payments for any dates of service during the deactivation period.
You can complete your revalidation using PECOS or by completing the correct CMS-855 application. Be sure that all requested documentation is also submitted with the application before the Medicare provided due date. DME suppliers must also submit the application fee.
Once your revalidation has been approved, you will receive a letter verifying the approval, PTANs, and effective dates. When this letter is received, please forward it on to your personal biller so that we can have that information on file.
Keep a close eye on your email and postal mail for any information regarding your provider revalidations and promptly return any required information. This will help eliminate any consequences of neglecting to revalidate your provider information.