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Affordable Care Act Requires Medicare Providers to Revalidate Their Enrollment By March 2013

As part of healthcare reform, Section 6401a of the Affordable Care Act requires all providers and suppliers who enrolled in the Medicare program before March 25, 2011 to revalidate their provider enrollment under the new screening criteria. Providers and suppliers who enrolled after March 25, 2011 do not need to revalidate at this time as they have already been screened.

The Centers for Medicare and Medicaid Services (CMS) designed and instituted new screening criteria in the provider enrollment process as another tool to curb Medicare fraud, waste and abuse. Each provider or supplier, whether newly-enrolled or revalidating, is assigned a risk level, either “limited”, “moderate” or “high”, representing the level of risk to the Medicare program for the particular category of provider/supplier. The designated provider risk level determines the amount of screening to be executed during the enrollment application process by the Medicare Administrative Contractor (MAC).

MACs will be sending revalidation notices to individual providers and suppliers between now and March 2013. Providers and suppliers must complete the enrollment forms within 60 days of receiving the request from the MACs. If a provider fails to submit the provider enrollment forms after receiving the request, it may lead to a suspension of the provider’s Medicare billing privileges.

Providers may revalidate their enrollment information by using Internet-based Provider Enrollment, Chain, and Ownership System (PECOS). Institutional providers are required by the Affordable Care Act to pay an application fee during the enrollment or revalidation process.

For more information about the provider enrollment or revalidation process, please contact a Wachler & Associates attorney at 248-544-0888.