February 2013 Almanac
American Orthotic & Prosthetic Association (AOPA) - February 2013 Issue - O&P Almanac
n Reimbursement Page By Devon Bernard, AOPA government affairs department Preparing for a Medicare Revalidation Tips to make the process as painless as possible M edicare is in the process of revalidating all suppliers who enrolled in the Medicare program prior to March 25, 2011, as mandated in the Affordable Care Act. The revalidation process should be completed by March 25, 2015, and after completion, the normal schedule of re-enrolling with the Medicare program every three years should resume. The reason the revalidation process is targeting everyone who enrolled prior to March 25, 2011, is because those suppliers were not subject to the revised Medicare enrollment standards. As you know, about two years ago Medicare revised its enrollment process for obtaining a supplier number and enrolling in the Medicare program. Those revisions include the following four key components: 1. Medicare has the ability to enforce an enrollment moratorium or put a hold on any future supplier enrollments. The enrollment moratoria would be in six-month increments and could be geographical in nature or by provider type. A moratorium would only be imposed if CMS identifies trends of fraud, waste, or abuse. Those moratoria would only apply to newly enrolling 14 O&P Almanac FEBRUARY 2013 providers or those enrolling new locations. 2. CMS can invoke payment suspensions, typically lasting for 18 months, based upon a â€œcredible allegationâ€? of fraud. An allegation of fraud may come from any source, including but not limited to the following: fraud hotline complaints; claims data mining; and patterns identified through provider audits, civil false claims cases, and law enforcement investigations. It is important to note that CMS does recognize there is a difference between fraud and billing errors that result simply in an overpayment. Thus, CMS will carefully review allegations before enacting payment suspensions. 3. CMS will have an enrollment fee. CMS will now charge a fee to enroll in the Medicare program. When you fill out an enrollment form, either the paper 855S version or the online PECOS version, for a new enrollment or a revalidation of your existing supplier number, you will have to include a fee to cover the processing of your application. The fee for 2013 is $532, but it does not apply if you are just making changes or updating information about a current location.