How-to: Check Medicare Revalidation Status

Do you need to revalidate with Medicare? Find out how to check your current Medicare validation status for both you and your practice.

Referenced Link:

Medicare Revalidation List



Recently we’ve received a few questions regarding Medicare revalidation. So we wanted to touch base with this again and equip you with the information that you need to be able to verify your current revalidation status with Medicare. It’s nothing to be too terribly concerned about, but it is something that you do need to check. It happens every five years, and if you’re not exactly certain, if you’re currently requiring revalidation, we’re going to give you the tool to be able to go out and check this. It would be important to check this on a periodic basis to make sure you don’t miss it. Also, watch your communication, it comes from CMS, and make sure that you follow through with the requirements for revalidation. And this applies to both you individually as well as your company your type two, NPI company, if you will, and you want to make sure that you double-check the validation for both of those particular entities.

Now, here’s how that’s going to work. Basically, I’m going to share my screen so you can see how this plays out. And what you want to do is you want to go to, that’s It’s going to take you to this Medicare revalidation list. And it’s really this simple, I want you to ignore most of the blanks on here and just really hone in on the search by NPI. And in this particular case, you’re going to enter in your NPI here, and then you’re going to click on find a provider. And once you do that, you’re going to see one of two things come up. The first is, if you have a revalidation that is due, you’re going to see if it’s an organization, this is exactly what it would look like. You’ll have the due date here of when the revalidation has to take place. Incidentally, if you have a due date, now’s the time to go ahead and complete your revalidation. You do that through the Pecos system. So go into Pecos and handle your revalidation there. And I’m going to talk about one of the components that come up in a question recently just to make sure that you’re covered on that and you don’t skip it. But due date here means to go to Pecos and complete your revalidation.

Now if you are not ready for revalidation, you will see this come up and you’ll see this come up is due date TBD, or to be determined in this particular case, there’s nothing for you to worry about nothing for you to do. So you want to go ahead and at that stage, don’t worry about it. Right? This is something to come back and check again. And check this every few months. But the biggest thing is this, you want to make sure that you watch closely, all of your Medicare communications. Because what we have seen is if you don’t go through the revalidation process, we’re seeing providers no longer be reimbursed by Medicare. So you want to make sure that that revalidation is complete. Now when you’re going through that revalidation, make sure you complete everything. Now, in theory, you shouldn’t be able to advance through and complete the entire revalidation if you haven’t done parts of it. But we have heard from at least one doctor who has had a challenge with the organizational chart. And so when they asked for the organizational chart, if you don’t upload that chart, they’ll basically send you a deficit issuance meaning that you have to provide additional information before they can complete your revalidation. And in those cases, many times you have to send it outside of the Pecos system, meaning mail it or fax it or some other types of communication.

So you want to make sure when you complete it, make sure you do everything including the organization chart. In that organizational chart. You’re not talking about all of your employees, you’re talking about those key role players in your organization. Typically it’s going to be used by the owner and any other people who you have listed as a member of your board of directors when you’re doing your group NPI, if you will, or if you’re doing your business revalidation in those cases. You know, we’re talking about if obviously, if you’re sole proprietor it would be you. If you’re a corporation, it’s going to be you and any listed officers/ directors and managing employees. Now, managing employees, this is somebody who has significant control over your practice. Somebody who’s making decisions for your overall practice day in and day out. That’s when they talk about managing plants. If somebody, basically at the CEO level of your company or your practice, if you have somebody in that role that is not you. And then these cases you just want to list all of your owners that have greater than 5% ownership in your practice. And so if there are multiple different physicians that have ownership in your Medical Corporation in those cases, you would list all of them in that organizational chart and make sure that you do upload that as a part of your revalidation. Hopefully, this information helps you out and we will catch you next week.

About Author

Marc Abla, CAE

Marc Abla began working at the Illinois Chiropractic Society in 2002 and became the Executive Director in 2008. He brings his extensive financial, administrative and association experience to the ICS. He is a Certified Association Executive and a graduate of the Certified Leadership Series through the Illinois Society of Association Executives. Additionally, he is a member of the Illinois Society of Association Executives, the American Society of Association Executives, Association Forum, Congress of Chiropractic State Associations, and the American Chiropractic Association.

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