CMS makes changes in how doctors revalidate Medicare enrollment information
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:
- Internet. Submit your revalidation information to the Medicare Provider Enrollment, Chain, and Ownership System (PECOS). You also can upload any supporting documentation there.
- Regular mail. Mail paper certification statements (Paper CMS-855) to your Medicare administrative contractor.
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.
Changes in coding and reimbursements worth knowing. Meanwhile, with the clock winding down on 2024, the AOA continues to press for Congress to act on reforms that would give doctors of optometry an annual, permanent inflationary Medicare payment tied to the Medicare Economic Index.
The federal government and private payers are heavily scrutinizing the use of modifier -25. When used appropriately, it can help to ensure that patients receive appropriate treatment and that doctors of optometry are reimbursed appropriately for their service. If you believe a claim that includes modifier -25 was inappropriately denied, follow appropriate criteria when appealing.