Revalidation

Revalidation is how Medicare checks that an enrollment record is still true. CMS requires providers and suppliers to renew the record periodically to keep billing privileges: every five years for most providers and suppliers, every three years for DMEPOS suppliers. The enrollment contractor sends a notice by email or post roughly three to four months before the due date, and CMS posts due dates about seven months ahead on the Medicare Revalidation List, so a biller can look a provider up without waiting for the letter.

The report that shows revalidation going wrong is the aging report. Missing the date can put a hold on Medicare payments or deactivate billing privileges outright. A deactivated provider has to file a complete new enrollment application, and Medicare does not pay for services furnished during the deactivated period. Those dates of service are not late; Medicare treats them as unpayable.

The mistake is waiting for the notice. Notices go to the contact on file, which is often a former office manager or a closed mailbox. Check the revalidation list for every enrolled NPI on a fixed schedule, start the application well before the due date, and answer any development request from the contractor quickly, because an unanswered request can end the same way as a missed deadline.