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New Medicare Revalidation/Deactivation Consequences for Group Practices & Practitioners

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New Medicare Revalidation/Deactivation Consequences for Group Practices & Practitioners

CMS has recently implemented new measures to ensure providers are aware of revalidation submission deadlines in an effort to minimize the number of deactivations. Failure to respond in a timely manner will result in claim denials. Starting this month, CMS has posted revalidation due dates by provider.

Since revalidation submission deadlines are now more transparent, CMS has implemented consequences for the non-submission of a revalidation application. If a group practice/practitioner is deactivated due to failure to respond to a revalidation or development request, the original effective date is not preserved and CMS will not issue a retroactive reactivation effective date for the gap in coverage. The provider’s new effective date will be the date the reactivation/revalidation application is received by the Medicare Administrative Contractor (MAC). Services provided to Medicare patients during the period of deactivation will not be reimbursed.

The following chart illustrates an example of the notification events leading up to the revalidation due date and subsequent deactivation:

Webblast Table 3

 * Due dates for providers who are more than 6 months away from revalidation will appear on the website as “TBD” (To Be Determined).  Providers with a “TBD” status should not submit a revalidation application, unless specifically requested by CMS or the MAC.

A provider’s revalidation due date will be the last day of a month (March 31, April 30, May 31, etc.), and the due date will likely remain the same in future years. Providers can avoid deactivation by submitting revalidation applications prior to their due dates and responding to development requests in a timely manner. Online PECOS submissions are encouraged over paper applications. Providers are encouraged to submit their revalidation applications within two (2) months of the due dates listed on the CMS website, even if they have not yet received an email/mail notice of the deadline.

PROVIDER’S RESPONSIBILITY FOR REASSIGNED BENEFITS

Each practitioner who reassigns benefits to more than one group/entity is expected to submit only one revalidation application which should include all groups/entities to which they reassign their benefits.

Murer Consultants has extensive experience in completing enrollment applications for all provider types, including revalidation applications. We are readily available to answer any questions or handle complete outsourcing for your provider enrollment needs. Please feel free to contact our office at (708) 478-7030 for additional information.

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