CMS Says Some Physicians Must Revalidate Medicare Enrollment

imagingBiz | A comprehensive anti-fraud initiative undertaken by the Centers for Medicare and Medicaid Services (CMS) under health reform law will soon force some physicians in the Medicare program to revalidate their individual enrollment records, the agency has announced.

CMS will gradually send revalidation requests by mail to over 1.4 million health professionals—more than 50% of whom are physicians – through March 23, 2012. Physicians who enrolled in the program on or after March 25, 2011 are exempt from the requirement because their applications were scrutinized under new, more stringent screening criteria,CMS says.

Professionals receiving a request will have 60 days to re-certify their enrollment information, which for some physicians will be similar to the process they first used to sign up with the program. Failure to submit the enrollment forms as directed may result in the deactivation of Medicare billing privileges.

According to CMS, revalidation efforts undertaken in the past have targeted much smaller segments of physicians, such as those who had not updated their enrollment within the past five years or medical suppliers in areas known to be at high risk for fraud. Medicare administrative contractors nationwide process about 27,000 new enrollments and more than 30,000 reassignments, or changes to billing and payment information, each month.

In March, CMS implemented additional program integrity defenses mandated by the health reform law to prevent fraud. Physician practices have reported long wait times for new applications to be approved since then.

The American Medical Association (AMA) is urging CMS to reconsider the revalidation initiative. “We have very significant concerns with this revalidation effort in light of the problems physicians have had with enrollment and revalidation efforts in the past,” says AMA President Peter W. Carmel, MD.

Meanwhile, the Medical Group Management Association (MGMA) advocates that professionals commence the revalidation process as soon as they receive a request. Physicians can set the wheels in motion using paper applications or online via CMS’ Provider Enrollment, Chain and Ownership System (PECOS). However, they must wait until their Medicare contractor issues a revalidation request before doing so.


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