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Know Your Date to Revalidate—Failure to Respond to CMS-855

Revalidation Request Within 60 Days May Result in Severe Penalties

November 11, 2011

The Affordable Care Act requires all Medicare providers and suppliers to revalidate their enrollment information under new enrollment screening criteria. This revalidation effort applies to those providers and suppliers that enrolled in the Medicare program prior to March 25, 2011. Thus, newly enrolled providers and suppliers that submitted enrollment applications to CMS on or after March 25, 2011 are not impacted.

Between September 2, 2011 and March 23, 2015, Medicare Administrative Contractors (“MACs”) will send out revalidation notices to batches of providers and suppliers on a regular basis. Providers and suppliers must wait to receive their individual notice before submitting their revalidation application. CMS has posted a listing of all the providers and suppliers to whom CMS has sent revalidation notices on the Medicare Provider-Supplier Enrollment Revalidation Page. To locate this listing, click on the “Revalidation Phase 1 Listing” in the Downloads section at https://www.cms.gov/MedicareProviderSupEnroll/11_Revalidations.asp.

Upon receiving the revalidation notice, the provider or supplier has 60 calendar days from the postmark date of the notice letter to submit complete enrollment information using either (a) the internet-based Provider Enrollment, Chain, and Ownership System (“PECOS”) or (b) the CMS-855 Medicare Enrollment paper application. Failure to submit a complete enrollment application and all supporting documentation (including the $505 enrollment fee for applications submitted in 2011) within 60 calendar days may result in CMS deactivating the provider’s or supplier’s Medicare billing privileges. This is precisely what happened in a recent case before the Department of Health and Human Services’ Departmental Appeals Board (“DAB”), where the DAB ruled that CMS properly revoked a doctor’s Medicare enrollment for failure to timely submit his revalidation enrollment information. Leonardo Torres Rodriguez, M.D. v CMS, CR2446 (October 11, 2011). Although the doctor claimed that he never received the revalidation notice, the DAB found the doctor’s claim to be unsupported. To make matters worse, the deactivation of the doctor’s Medicare billing privileges also resulted in the doctor being ineligible to reapply for enrollment in the Medicare program for a period of one year.

In order to ensure that your organization complies with the 60 day response requirement, you should alert individuals who handle the mail to be on the lookout for the revalidation notice. Attached is a sample revalidation letter that CMS has issued. In addition, someone in your organization should search the Revalidation Listing mentioned above on at least a monthly basis to see if your organization’s name appears on the list. Lastly, once you receive the revalidation notice, take the initiative to complete the appropriate application immediately, as it may take longer than anticipated to complete. If you should have any questions during the revalidation process, please feel free to contact us for assistance.


As part of our service to you, we regularly compile short reports on new and interesting developments and the issues the developments raise. Please recognize that these reports do not constitute legal advice and that we do not attempt to cover all such developments. Rules of certain state supreme courts may consider this advertising and require us to advise you of such designation. Your comments are always welcome. © 2011 Dykema Gossett PLLC.

As part of our service to you, we regularly compile short reports on new and interesting developments and the issues the developments raise. Please recognize that these reports do not constitute legal advice and that we do not attempt to cover all such developments. Rules of certain state supreme courts may consider this advertising and require us to advise you of such designation. Your comments are always welcome. © 2018 Dykema Gossett PLLC.