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American Association of Oral and Maxillofacial Surgeons

Practice Management & Allied Staff News & Materials

Medicare Enrollment Revalidation

November 23rd, 2011

CMS will require all Medicare providers to revalidate their enrollment information, regardless if they have revalidated their information within the current five year revalidation timeframe. CMS' new enrollment procedures are a result of Health Reform initiatives to minimize fraud within the Medicare program. This mandatory enrollment revalidation ties in with CMS' new provider screening and risk categories to help ensure that only legitimate providers and suppliers are enrolled in Medicare, Medicaid, and CHIP, and that only legitimate claims are paid. CMS stated physicians that enrolled in Medicare prior to 2003 (the time when the PECOS enrollment system went into affect) and who have not completed a Medicare enrollment application since that time may voluntarily re-enroll. Those who choose not to voluntarily come into compliance will be asked to do so through a revalidation process, which ensures that Medicare has complete and current information on all Medicare providers and suppliers and guarantees continued compliance with Medicare requirements. CMS has recently extended its revalidation deadline date from March 2013, to March 2015. It is critical to note that once a physician receives a request to revalidate, they are only given 60 days to respond to a contractor's request. Physicians who do not respond to a revalidation request could face revocation of their billing privileges. For more information on Medicare's revalidation please visit the CMS website.