How to handle Medicare Revalidation

Your providers need to revalidate Medicare enrollment every 3 years. Here’s how you handle Medicare Revalidation.

Categorized as Operations Tagged

Your providers need to revalidate Medicare enrollment every 3 years. 

Your providers need to complete the CMS 855I paper application. Alternatively, they (or you) can use PECOS to complete the revalidation online. 

If you are a group practice, then you should be using the CMS 855 B application. This is a good time to set up EFT (electronic funds transfer) for your group as well.

IMPORTANT – you need to respond within 60 days from the date the revalidation letter was sent. If you delay or disregard this, your billing privileges will be terminated.

Relevant medicare forms to use

For individual providers, you can use the CMS 855 I form. This can be used whether you are a physician or a non-physician.

However, supporting documents vary based on your “provider type”. Take note of these supporting documents for your particular provider(s).

Sometimes, you do have to submit (new providers) the CMS 460 form as well. However, if you do not submit this form (and are called non-par provider), you can still get more reimbursement from patients at a maximum rate of 115% of Medicare rates.

If you are a group practice, you will also need to reassign your payments to the business entity. This is done using the CMS 855R form.

When you enroll, you should be setting up for electronic funds transfer (EFT) using the CMS 588 form as Medicare is not going to issue you a paper check.

They will ALWAYS pay using EFT (good thing).

So, effectively, plan for using the CMS 855I, CMS 460, CMS 588 forms if you are registering a new solo practice.

If you are adding a new provider to your existing group practice, you are going to need the CMS 855I and CMS855R forms.

If you are NOT enrolled with the state intermediary, you are going to need the CMS855R. Sometimes, you are going to need the CMS460 form as well.