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  • CMS Clarifies Revalidation of Provider Enrollment

    Over the coming months and years, Medicare Administrative Contractors (MACs) will be asking physical therapists (PTs) and other providers to revalidate their enrollment by submitting a complete and up-to-date enrollment application. Providers should wait for the request from the MACs before submitting the revalidation. Upon receipt of the revalidation request, providers have 60 days from the date of the letter to submit complete enrollment forms. Failure to submit the enrollment forms could result in the deactivation of a provider's Medicare billing privileges.

    A provision in the Affordable Care Act required certain providers who are revalidating to pay an application fee of $505. This fee does not apply to PTs in private practice who are revalidating. It does apply to all institutional providers who are revalidating (eg hospitals, SNFs, rehabilitation agencies, etc). 

    The most efficient way to submit your revalidation information is by using the Internet-based PECOS, available at the Centers for Medicare and Medicaid Services' (CMS) Web site. If using PECOS, once submitted, you must print, sign, date, and mail the certification statement along with all required supporting documentation to the MAC.

    More information can be found in a Medlearn Matters  article issued by CMS.


    • If the application fee is required of all institutional providers can anyone explain why on the CMS website under Medicare Application Fee Downloads there is an Application fee requirements for Institutional Providers Matrix that has 'NO' under Outpatient PT/OT/SLP Services Providers in all 4 columns that indicate what enrollment actions will trigger the application fee? Notice it is a matrix defined as for 'Institutional Providers' not private practice providers? I have tried to get anyone from CMS Provider Enrollment to explain it to me and no one has been able to do so yet. Thank you for your input.

      Posted by Debbie Baxter on 11/1/2011 12:43 PM

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