Skip the CMS Revalidation Checklist and let Newport manage all of your provider’s Medicare Revalidations. Fundamental to maintaining your enrollment status with Medicare is to ensure the revalidation process is handled appropriately. The Newport operations team utilizes proprietary software called mCARE to automatically check the CMS website each month. For any provider with an upcoming due date, the provider’s profile in CARE is updated and the Newport team conducts all of the necessary steps for revalidation to ensure prompt/ accurate submission on all pending profiles and to avoid account deactivation.
- Automated CMS lookup tool for updated reval due dates.
- PECOS Provider Assessment – Our account management team will assess all of your providers and identify which ones have not updated or initiated their PECOS accounts and take appropriate steps to keep their accounts active.
- PECOS Account Management – Our team manages all PECOS updates for your providers.
A Medicare revalidation application ensures a provider’s enrollment remains active. To maintain Medicare billing privileges, every provider must resubmit and recertify the accuracy of their enrollment information generally every 5 years. Providers that do not submit a revalidation application risk termination from Medicare and lost revenue as a result of credentialing-related denials.
While the mandate seems straight forward, the notification process from Medicare to providers has created a huge issue. Medicare sends out multiple notifications by mail alerting providers that revalidations are due. However, notifications are only sent to the location that Medicare has on file. Therefore, if a provider switched groups and did not alert Medicare, the letter is unlikely to make it to their current group. This means it is also highly unlikely the provider will receive the “Do Not Forward” (DNF) letter stating that their Medicare reassignment had stopped. In this scenario it is not uncommon for deadlines to be missed, providers to be de-activated from Medicare, related physician accounts to be frozen, and revenue lost.
Providers that are de-activated must re-apply for Medicare billing privileges. When this happens the provider will receive a new Medicare ID number and a new effective date. Meanwhile, payments may be lost between the time they were terminated and the time the provider is reactivated.
Poorly managed Medicare revalidation processes result in missed deadlines, provider termination from plans, and physician’s accounts being frozen. When these things happen, significant revenue is lost.
As part of Newport’s credentialing services platform, our credentialing specialists will work on our client’s behalf to monitor and pursue timely Medicare revalidations. Newport’s cloud-based services platform relies on the use of our proprietary software called CARE (Credentialing and Revenue Enhancement). CARE makes it easy for our services team to conduct regular audits for each provider and payer in order to maintain an active participation status with Medicare. Newport’s work collaboration tools provide notifications of any event which may require attention including missed signatures, incomplete applications, etc. so that problems can be quickly resolved and lost revenue avoided.