Medicare revalidation: how the cycle works and how to see your due date. The date is public before the letter arrives.

Medicare revalidation is the periodic renewal of a provider's Medicare enrollment. Most clinicians and practices revalidate every five years, and equipment suppliers every three. The cycle runs from your last enrollment or revalidation. CMS posts each due date on the Medicare Revalidation List at data.cms.gov before your contractor's notice arrives. Until a date is set, the list shows TBD, and you file nothing.^AC

What revalidation is, and who has to do it.

Revalidation asks you to resubmit and recertify your whole Medicare enrollment record. That means every practice location, every NPI, and every group a clinician reassigns payments to. Medicare's regulation sets the cycle, and CMS can also ask for a revalidation off cycle.^C

Physicians, nurse practitioners and physician assistants revalidate. So do group practices. Two groups do not: clinicians enrolled only to order, certify or prescribe, and clinicians who have opted out of Medicare.^C Physicians, other practitioners and physician groups pay no Medicare application fee. Institutional providers and equipment suppliers do.^D

How to see your due date, step by step.

1. Open the Medicare Revalidation List

   It is a free CMS lookup at data.cms.gov. You can search for an individual clinician or for an organization.^AB

2. Read what it shows

   A date means CMS expects your revalidation by then. TBD means no date has been set for the current window. CMS refreshes the list on a regular schedule, so check it again rather than assuming.^BC

3. Check the practice and its clinicians together

   The list includes a view for groups that shows the clinicians who reassign to the practice and each one's due date. Each clinician's date can differ from the practice's own.^B

4. Wait for a date before you file

   CMS sets a limit on filing early. A revalidation sent further ahead of the due date than CMS allows, without a notice from your contractor, is returned unprocessed. CMS posts due dates at that same distance ahead, so once your date is on the list, or the notice has arrived, you are inside the window.^A

5. File through PECOS

   CMS calls PECOS the fastest way to revalidate. Paper CMS-855 forms still go to your Medicare contractor.^C

The notice, and where it goes.

Your Medicare contractor sends a revalidation notice a few months before the due date. It goes by email to the addresses on your past applications, or by post to the addresses on your enrollment record.^AC If the practice has moved, or the person who filed last time has left, that notice lands somewhere nobody reads. The list at data.cms.gov does not depend on your mail, which is why we check it directly.

What trips practices up.

The first is a partial application. A clinician who reassigns to more than one group has to list every one of them, and every practice location, on a single revalidation. A missing group or location can have its Medicare billing number deactivated, even when the rest of the record is fine.^C

The second is the follow-up request. When the contractor asks for more documents, it sets a deadline in that letter. Miss it, and billing privileges are deactivated.^C

The third is lateness, and it is the one that costs real money. CMS says a late revalidation can lead to a hold on Medicare payments or deactivation. A deactivated provider has to file a complete new enrollment application to come back, and Medicare will not pay for services during the deactivated period.^AD For a busy clinician, that gap is a run of visits nobody can bill.

Medicaid runs its own cycle.

Federal rules require every state Medicaid program to revalidate its providers at least every five years, and each state chooses how it tells providers. A state can rely on Medicare's screening in some cases, but it keeps its own records and its own agreements. A provider who does not respond to a state's revalidation is terminated from that program.^E Your Medicare date tells you nothing about your Medicaid date. Track them separately.

For practices whose enrollment we run, we keep both dates, for the practice and for each clinician, beside every other effective date in the enrollment file. When a date appears on the list, we file the revalidation against the full record, with every location and reassignment, without waiting for the letter.

Questions practices ask about revalidation.