7 Tips to Completing the Medicare Revalidation Application

Paperwork: the dreaded word! Everyone hates paperwork but, with the tightening of Medicare security to prevent fraud, this has meant an increased amount of paperwork.

Medicare revalidations come up every 3-5 years, depending on many factors. As your revalidation notices come in the mail (or email), don’t ignore them.

You get a 3-month warning before your Medicare enrollment expires, and if you don’t get the paperwork in and approved by the deadline, your claims will be denied. Depending on your payer mix, this is going to affect your revenue for the month. It may also cause a gap in coverage as Medicare may not backdate your application to the expiration date of your previous enrollment.

A benefit of having a lockbox service, as provided by Omni, is that we receive a copy of these notices as well and can remind our clients in case they were accidentally missed.

The last thing you want to deal with is a returned Medicare revalidation application because you haven’t filled out a section correctly. Here are 7 tips to keep in mind as you complete the Medicare revalidation paperwork:

Tip #1:

MedicareDid you know you can complete your Medicare revalidation application online at https://pecos.cms.hhs.gov/? It’s faster and easier, with basic checks to make sure you are completing everything before submitting the paperwork.

Why do it online, you ask?

  • Processing time is 45 days vs. the 60 days for paper
  • You must pay the fee through PECOS anyway, why not just complete the application while you’re there?
  • There are basic checks to make sure you are including all the relevant information before the application is submitted, reducing the back-and-forth with Medicare
  • You can update and/or edit information easily without having to redo the entire application. This is especially time-saving if you have already revalidated previously via PECOS, as you can simply update the information, without having to redo the entire application.

*Note: if your service shares a Tax ID with another department, be sure to register as a new user.

Tip #2:

Make sure the legal business name of your service matches corresponding IRS documents. If your service has changed its name, it needs to be updated with IRS before the changed name can be reported to Medicare.

 

Tip #3:

If the Delegated Officials or Authorized Officials have changed since your last Medicare revalidation, they need to be updated on your revalidation application. An authorized official is an appointed official who has the legal authority to enroll and make changes or updates to your service’s status in the Medicare program. A Delegated Official is a person delegated by the Authorized official to make changes and updates to the Medicare enrollment. As of the latest application, third party organizations (such as a billing service) cannot be Delegated Officials.

 

Tip #4:

Remember to complete vehicle information and provide a copy of vehicle registration for each ambulance in Section D. Some CMS providers also require a copy of your State EMS board vehicle license and DMV registration for each ambulance if issued.

 

Tip #5:

Items to include with revalidation:

  • Copy of NPPES or NPI letter with number
  • Copy of current state license
  • Copy of CLIA certification
  • Letter from IRS confirming your tax identification number.
  • Copy of liability insurance policy.
  • Copy of your Medicare revalidation notice
  • Copy of Board of EMS vehicle license and DMV registration for each ambulance
  • Copy of an attestation from government entities and tribal organizations accepting financial responsibility
  • If filing on paper, make sure to include:
    • Copy of PECOS payment
    • Signed certification statement

 

Tip #6:

If you are using a billing service such as Omni, be sure to complete Section 8. Make sure you get the correct name from your billing entity that matches their IRS tax forms. You may also add them as the contact person in Section 13 so they can contact Medicare about revalidation questions.

 

Tip #7:

If sending on paper, check, check, and re-check that all relevant sections have been filled out, signed AND dated by ALL required parties. Consider doing the application via PECOS online to at least make sure that all sections have been completed.

 

Other resources:

  • Medicare Revalidation Application Checklist
  • Webinars and How-To Guides on filling out the Medicare Revalidation application online at the bottom of the following page: Internet Based PECOS
  • Omni provides guidance to our clients on the entire revalidation process
  • A nice resource for checking whether your Medicare revalidation is due soon is CMS.gov/revalidation. If your Medicare revalidation is due within 3 months, the website will list the due date. Otherwise, it will list the status as TBA.

 

Grant Helferich is employed as the Director of Client Performance and Training with Omni EMS Billing in Wichita, Kansas. He is a former member of the KEMSA Board and has also served as the treasurer and president of the KEMSA Administrator’s Society. He was certified as an EMT, EMT-I, M.I.C.T. , and T.O. II. Grant has worked EMS for over 35 years in roles such as an EMT, EMT-I, M.I.C.T., Field Supervisor, Flight Paramedic, Cardiovascular Specialist, Assistant Director, and Director of EMS.

 

Billing a transport as ALS even though ALS services weren’t provided

Billing a transport as ALS even though ALS services weren’t provided

Did you know? In limited circumstances, Medicare allows services to bill a transport as an ALS transport even though ALS services were not provided, as long as proper documentation is included in the PCR, including:

  • Dispatch protocols
  • Reason for dispatch
  • an ALS assessment

Watch the video to learn more about billing a transport as an ALS transport under these circumstances.

*If video quality is low, you can improve it by clicking on the gear icon at the lower right side of the YouTube screen and choosing a higher quality*

 

Grant Helferich is employed as the Director of Client Performance and Training with Omni EMS Billing in Wichita, Kansas. He is a former member of the KEMSA Board and has also served as the treasurer and president of the KEMSA Administrator’s Society. He was certified as an EMT, EMT-I, M.I.C.T. , and T.O. II. Grant has worked EMS for over 35 years in roles such as an EMT, EMT-I, M.I.C.T., Field Supervisor, Flight Paramedic, Cardiovascular Specialist, Assistant Director, and Director of EMS.
How to Write Good Patient Care Reports (PCRs) – Part 4 of 5

How to Write Good Patient Care Reports (PCRs) – Part 4 of 5

Part 4 (of 5): Providing a Detailed Narrative

Last month, we shared the third part of a 5-part series on writing good patient care reports (PCRs), which focused on justifying medical interventions (See Full Article: How to Write Good Patient Care Reports (PCRs) Part 3 of 5: Justifying Medical Interventions).

This month we will be focusing on providing a complete, accurate, and detailed narrative in your PCRs.
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How to Write Good Patient Care Reports (PCRs) – Part 3 of 5

How to Write Good Patient Care Reports (PCRs) – Part 3 of 5

Part 3 (of 5): Justifying Medical Interventions

Last month, we shared the second part of a 5-part series on writing good patient care reports (PCRs) that focused on avoiding vague terminology (See Full Article: How to Write Good Patient Care Reports (PCRs) Part 2 of 5: Avoiding Vague Terminology in Patient Care Reports).

This month we will be focusing on justifying medical interventions documented in your PCRs.

Encourage your staff or colleagues to use these criteria as guidelines to writing complete and accurate PCRs that reduce the chance of insurance denials.
(more…)