AOPA Government Affairs News

Medicare Enrollment Revalidation Process for Providers and Suppliers

If you are a provider or supplier who enrolled in Medicare prior to March 25, 2011 you are required to revalidate your enrollment based on new risk screening criteria covered under ACA, also known as the Affordable Care Act.  If you enrolled in Medicare after March 25, 2011, the new risk screening criteria was used to process your enrollment and no current action is necessary.  CMS has announced that they adopted the new screening criteria under section 6401(a) of ACA to help CMS reduce fraud, waste and abuse.  The screening criteria consist of three categories of screening for providers or suppliers based on level of risk to the Medicare program– limited, moderate, or high.  The Medicare contractor who processes the provider’s or supplier’s enrollment determines the degree of screening to be performed.

For O&P providers and suppliers the applicable Medicare contractor is National Supplier Clearinghouse (NSC).  NSC is sending out notices through March 23, 2013, to individual providers and suppliers to begin the revalidation process for those that require it.  You must wait to submit your revalidation until being asked by NSC to do so.  Once you receive a request from NSC  you have sixty (60) days from the date of the notice to complete and submit the enrollment forms.  The most efficient method of completing this task is to revalidate through the internet-based Provider Enrollment, Chain, and Ownership System (PECOS), found by clicking here. The revalidation process requires institutional providers to pay an application fee set at $505 for Calendar Year 2011.  If you do not submit the enrollment forms as requested your Medicare billing privileges may be deactivated.  When CMS proposed these changes, AOPA strongly opposed both the three-level assignment of risk, as well as the application fee structure, but CMS ignored opposition from AOPA and others.

Click here to access the comments AOPA filed on behalf of O&P companies regarding these new policies.

Questions? Contact Catherine Graf at (571) 431-0807 or .