Revalidation

Everyone needs validation sometimes. I especially like it when my parking gets validated. Some people need their feelings validated. My driver’s license could use a little revalidation since it has expired and everyone loves a valid credit card. Medicare has also jumped on the validation bandwagon with a new requirement for revalidation 855a’s.

Raise your hand if you have no earthly idea what I am talking about. Good. You can quit reading now unless you own an agency or serve in a managing role. This includes the DON, CFO, Administrator, etc.

As some of you may have figured out by now, CMS has had a little issue with fraud and abuse over the past couple of years. Why just last week two more people in my little town of Baton Rouge were arrested. Many times, these ‘fraudsters’ as the FBI likes to call them, are not much more than shams. When the Feds go to arrest them, they aren’t even there.

So, in an effort to keep track of all their little contractors, CMS is now in the process of sending out letters to all providers asking for same information that would be provided for an agency enrolling as a provider. Furthermore, they are holding agencies to standards that may not have been in place when the agency was initially certified for Medicare.

This is not a complicated process. Any rocket scientist can figure it out. You just fill in the blanks and send it in. You have to pay first on the website. Some folks can even do it online. But if your organization is simple and the ownership structure is fairly normal, it is completely doable.

Here are some things to remember:

1. Do not send in a revalidation 855 until you are asked. I have a list of all providers who have received a letter. If your mailman is as confused as mine, drop me an email or send me some chocolate and I will look you up.
2. The ability of contractors to cross reference databases is phenomenal. If you have ever, even tangentially been associated with a person or provider who has been on Medicare’s naughty list, contact your healthcare attorney (or mine) prior to submission of the 855a to determine your risk. Failure to disclose something that Medicare deems relevant is the provider’s equivalent to cyanide.
3. Go for perfection. All typos will be discovered and brought to your attention as though they were blatant attempts to commit fraud.
4. Do not ignore your letter. This is not an option or a request from Medicare. If you fail to complete your revalidation 855a, you may very well find yourself unable to bill Medicare, Medicaid and a whole lot of other payor sources.
5. Know the legal name of your agency. Don’t laugh. You would be surprised how many people do not know the legal name of their agency.
6. If you are asked to sign a certification page and you do not own the agency, read it very, very carefully. You are signing that you are responsible for all activities within the agency and will ensure that they meet all Medicare Guidelines.

If you need help with your 855a, Alice Posseno, the quiet consultant at Haydel Consulting Services knows more about Medicare enrollment than anyone on the planet. I have no problems renting her out for your project.