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  • Medicare Enrollment Revalidation Required for PTs Enrolled Prior to March 25, 2011

    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."


    • /I am closing my P.T. office and am a Medicare provider. Do I have to revalidate my enrollment and how do I unenroll

      Posted by Kathleen Novick -> BLXc? on 8/12/2011 1:19 PM

    • How & where do begin? My experience: any time paperwork is given to Medicare----they stop all reimbursement. Not paid for 6 months the last time. My neurologist did not get paid for 10 months due to an address change. My family physician has not been paid for the past 7 months----filled out PECOS forms for Medicare.

      Posted by Mike Crossett on 8/12/2011 9:01 PM

    • I just moved one of my clinics to a new location and took 2 months to get Medicare to approve the change of ADDRESS but didn't have problem with reimbursement. The payment will be held by edicare if the tax ID or ownership is also changed, such as: getting incorporated. That's exactly what I did 2 years ago and moved at the same time and didn't receive payment from Medicare for 6 months.

      Posted by Jean Lin on 8/14/2011 6:42 AM

    • Does the new ruling mean as an esablished rehab agency for 20 years we need to revalidate via an application and pay $500.00?

      Posted by Brenda Leisinger -> @KXcB on 8/15/2011 5:07 PM

    • I am chief of an outpatient PT practice. We have been in business for 39 years. Do we need to revalidate? Really?

      Posted by Richard Baldwin, PT on 8/31/2011 8:04 AM

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