Health Law Wire: Physician Medicare Revalidation Notice


On January 29, 2014, the National Government Services, Inc. announced that it would begin mailing out revalidation notices (“Notice”) to physicians enrolled in the Medicare program sometime in the next (12) months. Physicians enrolled should expect to receive a Notice in the coming months and must submit the revalidation application within (60) calendar days upon receipt of such Notice to avoid potential deactivation of their Medicare Provider Number (MPN) and billing privileges.

How will the Notice be delivered?
Physicians will receive the Notice by mail in a yellow-envelope from their respective Medicare Administrative Contractors (MAC). In addition, the Notice will be posted on, and it will be listed on the Internet-based Provider Enrollment, Chain and Ownership System (PECOS). Physicians are only required to submit the revalidation application after being notified by their MAC.

What address will the Notice be mailed to?
The Notice will be sent simultaneously to the special payments and correspondence addresses on record and/or physical location of the physician’s practice. If these are the same, it will also be mailed to the primary practice address. Contact your Medicare enrollment contractor and ask if you have an enrollment record in PECOS.

Will all of the members in a group practice get a Notice at the same time?
No. Groups and Individuals that reassign benefits will be sent separate independent notices. Regardless of a physician’s reassignment status, they are responsible for revalidating their own record.

When should Physicians expect to receive a Notice?
All new and existing physicians must revalidate enrollment information by March 23, 2015. CMS requires all enrolled providers and suppliers to go through the revalidation enrollment process every five (5) years.

What happens if the revalidation enrollment application is not returned within (60) days?
The failure to submit a complete revalidation enrollment application(s) and all supporting documentation within (60) calendar days of the postmark date of the Notice may result in your Medicare billing privileges being deactivated. CMS has instructed the MACs to conduct multiple outreach attempts before administrative action is taken.

Can an extension be requested and what reasons are approved?
Yes. The request may be made by phone or submitted in writing and addressed to your MAC. There are a wide number of reasons and CMS has instructed MACs to accept all reasonable requests. If additional time is required to complete the Application(s), the physician may request one 60-day extension, which will begin on the date of the request.

Is an Application Fee due with the revalidation?
No. Physicians, non-physician practitioners, physician group practices and non-physician group practices are excluded from paying the Application Fee unless enrolling a supplier of durable medical equipment, prosthetics, orthotics and supplies (DMEPOS).

DISCLAIMER: Because of the generality of this update, the information provided herein may not be applicable in all situations and should not be acted upon without specific legal advice based on particular situations.

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