How to Steer Clear of Medicare PTAN Deactivations

DME suppliers are shocked to find out Medicare has deactivated their billing number. The most common reason for a deactivated PTAN is – far and away – the supplier’s failure to respond to an inquiry from one of the National Provider Enrollment contractors (NPEs).

Fortunately, that is something suppliers can proactively protect themselves against.

Never Ignore NPE Development Requests

That much is obvious.

It is a bad idea to outright ignore any request from any Medicare contractor. Failing to respond is effectively withholding information from Medicare, and that violates Supplier Standard 21:

“A supplier must agree to furnish CMS any information required by the Medicare statute and regulations.”

But in our experience, suppliers don’t often disregard requests. Instead, they respond and assume the requesting agency has what it needs without any confirmation or follow up. Medicare agencies do not distinguish between no response and an incomplete one. If the agency doesn’t get what it needs, it initiates deactivation.

Medical Resuppliers should call the NPEs to make sure they understand the request before responding, and they should follow up afterwards to make sure the matter is resolved before the 15-day development window closes.

Do Not Overlook NPE Requests Sent via Email

“But I never received it!” doesn’t cut it.

NPEs typically send development requests via email to the point of contact listed in PECOS. Suppliers should regularly verify the PECOS contact name and email address is current. Points of contact, for their part, should check their spam folders weekly to make sure they don’t miss time sensitive messages, especially when any PECOS application is pending.

Medicare Requires Revalidation Every Three Years

Suppliers should be on high alert after submitting any application to modify PECOS, and should remain so until Medicare completes the change. Regular revalidation, however, can sneak up on distracted suppliers. To avoid missing information requests related to revalidation, suppliers should check the CMS website at least twice each year to avoid missing Medicare-initiated development requests.

To check for an upcoming revalidation due date:

1. Visit the Medicare Revalidation List at https://data.cms.gov/tools/medicare-revalidation-list.
2. Query the supplier using the NPI or company name.
3. Click “Find a Provider.”

Revalidation is due on the date listed by “Due Date” if the date is in the future. NPE contractors accept revalidation applications up to seven months before the posted due date.

“TBD” means there is no pending requirement. Do not initiate revalidation when there is no date listed.

Ultimately, a comprehensive PTAN deactivation prevention strategy requires suppliers to:

1. Check the Medicare Revalidation List semi-annually.
2. Maintain high alert when any PECOS activity is pending.
3. Ensure PECOS records list current contact information for individuals responsible for responding to Medicare requests… and those individuals regularly check their spam folders for communications and development inquiries.
4. Respond to all requests.
5. Follow up regularly with requesting agencies to ensure favorable resolution.