American Speech-Language-Hearing Association
August 17, 2011

SLP and Audiology Medicare Providers Must Revalidate Enrollment

All speech-language pathologists (SLPs) and audiologists who enrolled in Medicare prior to Friday, March 23, 2011, will need to revalidate their enrollment at some point between now and March 2013. This is due to new risk screening criteria required under the Affordable Care Act (ACA) which was implemented by the Centers for Medicare and Medicaid Services (CMS) in March 2011. The new risk screening criteria places providers and suppliers in one of three screening categories—limited, moderate, or high. These categories represent the level of risk to the Medicare program and determine the degree of screening that will be done by the Medicare Administrative Contractor (MAC) processing the enrollment application that will be submitted for revalidation. SLPs and audiologists enrolled as individuals or group practices are placed in the limited category. The enrollment process for providers and suppliers in the limited category remains unchanged.

Between now and March 2013, MACs will send revalidation requests to individual providers and suppliers enrolled in Medicare. SLPs and audiologists should submit complete enrollment forms to their MAC within 60 days of the revalidation request. An SLP or audiologist who does not submit enrollment forms as requested may lose Medicare billing privileges. CMS encourages providers and suppliers to revalidate enrollment information by using Internet-based PECOS (Provider Enrollment, Chain, and Ownership System).

More information about provider revalidation can be found in the Medicare Learning Network's Special Edition Article #SE1126, titled, "Further Details on the Revalidation of Provider Enrollment Information," or the Medicare Program Integrity Manual, Chapter 15, section 15.19.2. Further questions may be directed to Kate Romanow, ASHA's director of health care regulatory advocacy, by e-mail at kromanow@asha.org or Mark Kander, ASHA's director of health care regulatory analysis, at mkander@asha.org.


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