Archive for August, 2011

More Changes….

Wednesday, August 31st, 2011

The past 12 months have been very busy….with Medicare revalidation & PECOS enrollment, J15 conversion for KY & OH Medicare Part B Providers, and the recent change in KY Medicaid to a managed care model. (I won’t even mention EHR incentives, meaningful use and preparing for 5010!) But, it appears there is even more change on the horizon for Medicare participating providers.

All providers enrolled in the Medicare program prior to March 25, 2011 will be required to revalidate their enrollment, utilizing the new risk criteria under the Affordable Care Act (section 6401a). Providers will fall into one of three categories-limited, moderate, or high. Each represents the level of “risk” to the Medicare program for the particular category a provider or supplier falls under. For a complete list of these screening categories, and the provider types assigned to each, please refer to Chapter 15, Section 19.2.1 of the CMS “Program Integrity Manual”.  One major change will be that certain provider types will be required to pay an application fee when revalidating! Those specifically mentioned are institutional and supplier providers.

Medicare Administrators will begin sending out notices between now and March 2013. When notice is received, providers will have 60 days from the date on the letter to get their enrollment forms accurately completed and submitted for processing.

For more information about this topic, please refer to the Medicare Learning Network’s “Special Edition Article #SE1126″, titled “Further Details on the Revalidation of Provider Enrollment Information”, at http://www.CMS.gov/MLNProducts/downloads/MedicareAppealsProcess.pdf.