Revalidation: Check the list twice

Friday, November 18, 2011

WASHINGTON – CMS has some kinks to iron out in a huge revalidation project that it kicked off in September, but that shouldn’t stop providers from doing their part, industry stakeholders say.

From Sept. 2 to Oct. 17, CMS mailed out its first batch of letters requesting that more than 100,000 Medicare providers—everyone from docs to HME providers—revalidate their enrollment information. It also posted a list of those providers to its website.

The problem: There have been numerous reports of providers who are on the list but who haven’t received letters, creating confusion.

“I queried the list for some of my clients and I came up with eight providers,” said Sylvia Toscano, owner of Professional Medical Administrators. “Four of them had not received letters.”

The letters provide instructions for revalidating enrollment information: Providers can submit an updated 855 form; or they can review, update and certify information in PECOS. They must also go to to pay a $505 fee.

There has also been confusion over whether providers must complete the process in 35 or 60 days. The letters that providers have received say the former; a sample letter on CMS’s website says the latter.

“It’s 60 days,” said Andrea Stark, a reimbursement consultant with MiraVista. “There was a typo on the NSC side, when the letters went out to providers.”

Stakeholders recommend that providers check the list for their NPI numbers, and if they’re on the list, go through the revalidation process as soon as possible, whether they’ve received a letter or not. They say to use the sample letter as a guide.

“Providers need to be anticipating this,” Stark said. “It’s only 60 days and if you want to do it through PECOS, which you should, and you’re not already enrolled, it takes a couple of weeks just to go through that process.”

CMS launched the project per Section 6401 of the Affordable Care Act, which requires all providers who were enrolled prior to March 25, 2011, to revalidate their enrollment information under new screening criteria. Between now and 2015, CMS will pick away at revalidating all of these providers by sending out more letters and updating the list.

“We’re hearing the list is going to be updated monthly,” said Rose Schafhauser, who sits on the NSC Advisory Committee.

For the sample letter and the list, go here.