Reasons for Deactivation of Medicare Billing Privileges/Suspension of Payment

• Inactivity
• Failure to complete revalidation within required time frame
• Unreported provider address change

Inactivity

Medicare will routinely deactivate the billing privileges of those providers who fail to bill the Medicare Program for four consecutive quarters. Each billing account is considered separately for the deactivation criteria. This means that a provider who is affiliated with a group may be deactivated under his individual Medicare billing account, yet the group member Medicare billing account remains active. Notification is not done prior to deactivation.

Failure to Complete Revalidation

Providers who fail to complete the required revalidation process within 60 days of the date of the revalidation letter from their MAC also risk deactivation of Medicare billing privileges.

Reactivation of Billing Privileges

To reactivate your individual and/or group billing privileges, please follow these instructions:

• If an individual provider billing account is deactivated, the provider is required to submit a completed CMS-855I Medicare Enrollment Application form for Physicians and Non-Physician Practitioners. Internet-based PECOS.

Note: Sole proprietors who are incorporated must also complete the Complete the CMS-855I Medicare Enrollment Application form for Physicians and Non-Physician Practitioners – this can be done using the paper form or online using Internet-based PECOS. A type II NPI is required for your corporation and is reported in Section 4A of the form.

• If the group member billing account is deactivated, the group is required to submit a completed CMS-855R Medicare Enrollment Application form for Reassignment of Medicare Benefits, and if the members have no active account in Medicare, the CMS-855I Medicare Enrollment Application form for Physicians and Non-Physician Practitioners must also be completed. This can be done using the paper form or online using Internet-Based PECOS.
• If the group billing account is deactivated, the group is required to submit a completed CMS-855B Medicare Enrollment Application form for Clinics/Group Practices and Certain Other Suppliers and CMS-855R Medicare Enrollment Application form for Reassignment of Medicare Benefits.
• Please Note: The  CMS-588 Electronic Funds Transfer (EFT) Authorization Agreement (01/17) form is also required if you do not currently receive your payments electronically, or if your bank account information has changed.

Provider Address Changes and Do Not Forward Initiative

All Medicare providers are responsible for providing their Medicare contractor with their current and accurate mailing address.

The DNF Initiative became effective 10/1/2002. With implementation of the DNF Initiative, contractors were required to use “return service requested” envelopes for hard copy remittance advices (RA), in addition to using them for hard-copy checks.

If you are a provider that has elected to receive hard copies of RAs or checks and the post office returns either document to us due to an incorrect address, we must follow the CMS guidelines for the DNF Initiative. Your provider file will receive a DNF flag. No further payments or RAs will be generated until you furnish a new address that is verified.

Under the DNF Initiative, you as a provider are required to update all addresses before the Medicare contractor can remove the DNF flag. This includes:

• payee address
• billing address and 
• corporate address (if applicable)

You will need to submit a CMS-855 to the Medicare contractor with the correct section completed to change your address. If you do not have an established enrollment record in PECOS, you will be required to complete an entire CMS-855 application for your business type. Additionally, any provider that is not currently receiving payments through EFT will need to complete a CMS-588 Electronic Funds Transfer (EFT) Authorization Agreement form.

Once this has been done and all addresses have been verified, Medicare will remove the DNF flag. From that point we will pay any payments that were on hold due to the DNF flag. Any remittance notice that has been held can be requested by the provider through the IVR system.

It is important to notify Medicare 30 days in advance of your address change. This will help you avoid the hassles of a DNF flag and a delay in your payments. Any address changes received in advance of 30 days will be returned.

Physicians and nonphysician practitioners may also use Internet-based PECOS which makes address changes easier by allowing submission of changes through the Internet.