Medicare begins mailing provider enrollment

revalidation notices

Posted 10-18-11

Physicians who enrolled in th Medicare program prior to March 25, 2011, will be required to revalidate their enrollment by March 25, 2013, under new risk screening criteria required by the federal health reform legislation. California's Medicare contractor, Palmetto GBA, has recently began notifying physicians via mail of this requirement. The notices contain instructions for the revalidation process.

The revalidation requirement is necessitated by new screening criteria that were implemented this past March. Newly enrolling and revalidating providers and suppliers will be placed in one of three screening categories representing the level of risk to the Medicare program. The level of risk will determine the degree of screening to be performed when processing the enrollment application.

Palmetto is first notifying physicians and other organizations that ar enrolled in Medicare, but do not yet have complete profiles in Medicare's online enrollment system, PECOS. Other physicians and providers will receive notices over the next 18 months, in an order still to be determined. Upon receipt of the revalidation notice, physicians and organizations have 60 days to respond. Failure to respond may result in deactivation of your Medicare billing number.

Do not do anything until you get a letter instructing you to revalidate. (This is very important in order to ensure an orderly enrollment process). Physicians who are making changes (moving, closing their practice, etc.) should continue to submit their changes as usual.

Institutional providers will be required to pay an application fee of $505 to enroll or revalidate. This does not apply to physicians or physician groups. Note, however, that physicians or other providers enrolling as suppliers of durable medical equipment, prosthetics, orthotics and supplies must submit the required application fee.