AddVal, Inc. | Unrivaled Medical Credentialing Expertise!

Medicare Revalidation by Dan Patrick

Please keep in mind that Medicare revalidations reoccur every (2) years. We continue to get distress calls from our practices that Medicare is denying claims. The claim denials are because the original Medicare requests for revalidation were ignored. The letters may be addressed to the physician & your staff may place them with their mail – please be sure ALL Medicare letters are handled the same day they are received.

PLEASE, do not ignore these letters! These letters define the revalidation process being requested and Medicare will deactivate your billing privileges if the revalidation process is not completed as requested. In other words- all claims will be denied until the revalidation process is complete!

Don't stress the mess of Medicare Revalidation, that's our job! For AddVal clients, as soon as we receive the revalidation request, we process the forms for the physicians' review & signatures. As soon as the physician returns the signed forms to us, we scan copies of all the documents for our records. This way, when Medicare starts processing the forms, we have access to what was submitted and are able to answer any questions that arise. To put the icing on the cake, AddVal follows-up regularly with Medicare after we submit your Medicare revalidation application and ensure its completion. There is no "black hole" approach when AddVal handles your credentialing!

Be sure to respond to your Medicare revalidation letters within the sixty (60) day time frame. If the Medicare revalidation application is not submitted within that time frame, your Medicare payments will be at risk until the Medicare processes are completed.

HIPAA & HITECH Modifications

As many of you know, modifications went into effect September 23rd, 2013. These changes include:

  • Updates to the business associates' liability.
  • Strengthened limitations on the use of protected health information (PHI) for fund raising & marketing.
  • Electronic copies to patients of their HER.
  • Restriction of release of information to their health plan for services the patient paid for in full.
  • Increased fines for noncompliance and a revision of the term "breach".

If you haven't yet done so, be sure to update and revise your compliance policies and procedures in order to be up-to-date with all modifications.

Changes, Mergers and More...

With the implementation of the Affordable Care Act coming quickly, the horizon for insurers and health plans continues to change often. One of the most recent changes is the merger of CIGNA, HealthSpring and Bravo. As is usually the case, the merger is moving slowly and affecting regions differently as decisions are made regarding network closures and other important issues. As our clients know, when a network is closed, it is extremely important to investigate the network status regularly. As soon as the window opens for a network, it is important to respond immediately. We monitor the status of any closed networks affecting our clients so their credentialing can be done as soon as possible. Another benefit, exclusive to AddVal, Inc.!

If you need any help with Medicare credentialing or credentialing with any commercial insurers, or you are concerned about the Medicare Revalidation please contact AddVal for assistance at 215-396-8972, mmcfarla@addvalinc.com.


About Add Val, Inc.

AddVal, Inc., based in Southampton, PA, currently serves over 5,000 clients across the U.S., providing experienced medical credentialing services. The company employs a unique blend of talented individuals experienced in clinical administration, healthcare insurance and medical credentialing. This team, combined with a singular focus on credentialing, produces unrivaled results for clients.

AddVal, Inc

Unrivaled Medical Credentialing Expertise
AddVal, Inc.
607 Lakeside Drive
Southampton, PA 18966

Telephone: 215-396-8972    |    Fax: 215-364-2187    |    Email: mmcfarla@addvalinc.com