Time to Re-Up

Doctors who have been enrolled in Medicare before March 25 this year and have Medicare patients will have to revalidate their Medicare enrollment as part of the new healthcare reform law going into effect.  Doctors who must re-enroll will be notified by their administrative contractors.

The requirement is part of the health care reform law’s effort to combat fraud.  Section 6401(a) of the Patient Protection and Affordable Care Act mandates screening procedures under new criteria for physicians and other health care providers of Medicare and Medicaid beneficiaries as well as those who participate in the Children’s Health Insurance Program.  

Just as with initial credentialing applications for Medicare/Medicaid, contractors will evaluate the re-enrollment using the new criteria.  Contractors will be provided with a list of physicians and health care professionals who have had a prior adverse action, such as license revocation, felony conviction or exclusion from federal health care programs.  New enrollments and revalidations will be checked against this list and physicians on the list could draw higher levels of scrutiny.

The revalidation notification will continue through March 23, 2013.  Once the physician receives the revalidation notification is received, providers will be given sixty days to respond to the request.   However, no action will be required if a provider enrolled on or after March 25, 2011 because these providers’ applications are already subject to a stricter level of scrutiny.   “Failure to submit the enrollment forms as requested may result in the deactivation of your Medicare billing privileges,” CMS stated.