In accordance with 42 C.F.R. § 424.515, all healthcare providers participating in Medicare are required to periodically revalidate their enrollment records with the Centers for Medicare & Medicaid Services (CMS) in order to maintain Medicare billing privileges. This routine process requires providers to confirm and, if necessary, update their enrollment information.
Revalidation generally occurs every five years for most providers and every three years for durable medical equipment suppliers. As part of this process, providers must review their existing enrollment information and confirm or update details such as ownership, practice locations, managing employees, and contact information.
Several months prior to the applicable deadline, the provider’s Medicare Administrative Contractor (MAC) typically sends a notice advising that revalidation is due. However, providers must ensure that their contact information and address on file are current. CMS specifically states that, although courtesy reminder notices are commonly issued, providers remain responsible for tracking and complying with their own revalidation deadlines.
Providers may verify their revalidation due date by searching the Medicare Revalidation List, which allows individuals and organizations to confirm upcoming deadlines. Revalidation applications may be submitted up to three months prior to the assigned due date. CMS strongly encourages providers to submit their applications electronically through the Provider Enrollment, Chain, and Ownership System (PECOS), which is the agency’s online enrollment system.
Failure to timely submit a revalidation application may result in deactivation of the provider’s Medicare billing privileges. When billing privileges are deactivated, the provider may not submit claims to Medicare for services furnished during the period of deactivation, and Medicare will not reimburse those claims. Because services provided during this time cannot be billed retroactively, deactivation can result in significant financial losses. In certain circumstances, the provider may also experience temporary interruption of Medicare enrollment until the revalidation process is completed and billing privileges are restored.
For these reasons, providers should regularly monitor their revalidation status, ensure their enrollment information remains current, and submit revalidation applications well in advance of the applicable deadline.
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