All physical therapists (PTs) who enrolled in the Medicare program before Friday, March 25, 2011, must revalidate their enrollment under the new risk screening criteria required by the Affordable Care Act (ACA).
CMS implemented new screening criteria to the Medicare provider and supplier enrollment process beginning in March 2011. Under the new ACA requirements, newly enrolling and revalidating providers and suppliers are placed in 1 of 3 screening categories: limited, moderate, or high. The screening category of the provider or supplier determines the degree of screening to be performed by the Medicare Administrative Contractor (MAC) processing the enrollment application. As a PT, your level of screening will depend on the setting in which you practice. For example, PTs enrolling as
individuals or as group practices are in the "moderate" risk category and will be subject to onsite visits by MACs. A detailed APTA summary of the final enrollment requirements for physical therapists can be found here.
Between now and March 2013, MACs will be sending notices to individual providers and suppliers. CMS recommends that providers and suppliers begin the revalidation process as soon as they hear from their MACs. Upon receipt of the revalidation request, providers and suppliers have 60 days from the date of the letter to submit complete enrollment forms. Failure to
submit the enrollment forms as requested may result in the deactivation of your Medicare billing privileges.
For more information about provider revalidation, review the Medicare Learning Network's Special Edition Article #SE1126, titled "Further Details on the Revalidation of Provider Enrollment Information."