CMS makes changes in how doctors revalidate Medicare enrollment information

April 20, 2016
Failing to revalidate could put doctors’ Medicare payments at risk.

The Centers for Medicare & Medicaid Services (CMS) has made changes to how doctors of optometry revalidate their Medicare enrollment information. Failing to revalidate could put doctors' Medicare payments at risk.

The changes are designed to reduce the burden on providers by making the revalidating process that occurs every five years simpler, according to CMS. Revalidation is the process of resubmitting and recertifying the accuracy of a provider's enrollment information.

Among the new process improvements are:

  • Established due dates. Revalidation due dates are now based on the last day of the month (e.g., June 30 or July 31). Sixty to 90 days before doctors are due to revalidate, notices will be sent by their Medicare administrative contractors via email or through regular mail. Due dates will generally stay the same for future revalidation cycles.
  • An online tool to look up providers' revalidation due dates. Doctors can find their due dates on a new CMS revalidation lookup tool. The online tool will display due dates up to six months in advance, if a provider is up for revalidation within that time frame. If a provider is not up for revalidation in the next six months, the site will display a "TBD" or to be determined.

Doctors have two options for revalidating. They can resubmit their information via:

CMS warns that if doctors are within two months of their due dates, and haven't received notice from their Medicare administrative contractor, they should go ahead and submit their revalidation application.

Failing to revalidate or not providing all information to the Medicare administrative contractor by the deadline could result in a hold on doctors' Medicare payments and possible deactivation of their Medicare billing privileges. Doctors won't be paid for services performed during deactivation.

"So we encourage all providers to submit complete and full applications to their contractor when it's time for them to revalidate and respond to all contractors' requests for information to avoid your enrollment being deactivated," Alisha Banks, director of CMS' Division of Enrollment Operations, Center for Program Integrity, said during a conference call March 1 with providers.

Related News

If it sounds too good to be true, it probably is

In assessing new products, consider first what is best for your patients and practice—but also consider reimbursement related to new equipment.

New E/M codes: Is time on your side?

While how time is considered has changed, it is critical to remember that usage of the prolonged service modifier also has changed.

Coding ethically: What to do when a coding decision is made incorrectly

The AOA Ethics and Values Committee releases topical and timely case study on coding abuse and what to do about it once suspected.