2017 Spring Convention

Transcription

1 2017 Spring Convention Medicare Revalidation Paul Andrews

2 Please scan IN at the start of class Please scan OUT at the end of class You must attend the entire session to earn your credit(s) for this class

3 Revalidation Medicare B providers must revalidate their enrollment record information every five years. CMS sets every provider's revalidation due-date at the end of a month, and posts the upcoming six months online. A due date of TBD means that CMS has not set the date yet. Why must I revalidate? Section 6401 (a) of the Affordable Care Act: Established new screening requirements for new and existing providers/suppliers Required all existing providers/suppliers to be revalidated under new screening requirements Reinforces the revalidation requirements at 42 CFR

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5 Search results Individual provider lookup results

6 Search results Group practice lookup results

7 How will I know when to revalidate? Revalidation Notices sent via /mail Your Medicare Administrative Contractor (MAC) will send a revalidation notice within 2-3 months prior to your revalidation due date Will identify organizations to which individual providers reassign benefits Sent to addresses reported on your prior applications, or Sent via postal mail to at least two of your reported addresses Correspondence address Special Payments address and/or Your primary practice address NOTE: If you are within 2 months of the listed due date on but have not received a notice from their MAC to revalidate, you are encouraged to submit your revalidation application.

8 Sample notice of revalidation

9 How to revalidate Revalidate your entire enrollment record, including: All active practice locations Current reassignments The most efficient way to submit your revalidation information is via Internet Based PECOS. Review information currently on file Update and submit your revalidation Electronically sign after uploading supporting documents; or print, sign, date and mail your paper certification along with supporting documentation

10 What happens if I don t revalidate? Submit a complete revalidation application by your due date, and respond on time to all related requests from your MAC to avoid: Possible hold on your Medicare payment Deactivation of your Medicare billing privileges Deactivated providers will be required to submit a complete application to reactivate their enrollment Will maintain their original PTAN Reactivation date will be date of receipt of new complete application No payments will be made for the period of deactivation

11 What do I fill out? (paper) Medicare Applications CMS-855I For Individual Application (includes attaching services to a One Person entity such as a Corporation, LLC, or Sole Proprietor EIN #) CMS-855B Group/Supplier application for entities with more than one owner / partner. CMS-855R Re-assignment of Benefits application (used in conjunction with 855B) CMS-460 Participating Provider Agreement CMS-588 Electronic Funds Transfer (EFT) application

12 What do I fill out? (electronic) Medicare Provider Enrollment, Chain, and Ownership System (PECOS) Use your Individual NPI (NPPES) database user name and password Individual revalidation Group revalidation

13 Tutorials Step by step instructions & demonstrations

14 Revalidations / Credentialing Consistency in information is a key to successful credentialing / revalidation All things should reflect the same information NPI Database name and address IRS Information name and address Bank information name and address Medicare Applications when completing

15 NPI Is your Doctor s NPI File up-to-date?

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17 Please scan OUT as you leave If you are staying in this classroom for the next session you must have your badge scanned OUT for this session and scanned IN for the next session Thank you! Mark & Paul

18 Disclaimer TOP Education & the instructors acting on behalf of TOP Education are here this weekend to educate. They are not representatives nor speak on the behalf of any Insurance Company. Any discussion of a specific Insurance Company is for examples purposes only. All carrier specific policy or procedure questions should be directed to that carrier