Medicare Enrollment: All You Need to Know

Many of the topics I write about come directly from the questions our clients and O&P practice owners bring to us. Over the past six months, one issue has consistently surfaced: PTAN numbers, site visits, revalidations, and revocations of PTAN numbers. What Is a PTAN? A Provider Transaction Access Number (PTAN) is a Medicare-only identifier issued once your Medicare enrollment application is approved. Every provider who bills Medicare must have one for each practice location. Key Facts: Each location needs its own PTAN. If your practice has multiple sites under a single tax ID, every location that provides services must maintain its own PTAN. They become inactive after 12 months. If no claims are submitted under a PTAN for a full year, Medicare will automatically deactivate it—a common pitfall for many practices. PTANs are managed through PECOS. PTANs can be verified and updated through the Provider Enrollment Chain and Ownership System (PECOS), Medicare’s online portal. Revalidation occurs every three years. You’ll typically receive an email or mailed reminder, but it’s your responsibility to track and complete revalidation. You can look up your revalidation date at data.cms.gov/tools/medicare-revalidation-list. Changes must be updated promptly. Any change to the information on your original 855S enrollment application, such as a new address, billing agent, or delegated official, must be reported within 30 days. We have received multiple calls where our client wasn’t expecting a site visit because the revalidation notice was sent to an email address that was no longer valid. However, Medicare expects all providers to be inspection-ready during business hours. Medicare Site Inspections: What to Expect Because PTANs are tied to your practice location, Medicare Administrative Contractors (MACs) such as Novitas, CGS, and NGS conduct site inspections to confirm compliance. The date of the inspections are unannounced and occur under the following circumstances: After initial enrollment to verify your practice exists, is operational, and meets DMEPOS Supplier Standards Triggered later by complaints, suspected fraud or abuse, billing inconsistencies, ownership changes, relocation, or inactivity under a PTAN for 12 months Revalidation Best Practices for PTAN Management and Site Readiness Maintain a central log of all active PTANs, linked to practice locations, and with revalidation dates. Review annually to confirm each location has billed Medicare within the past 12 months. Keep a compliance binder at each site with PTAN confirmations, accreditation, licenses, and supplier standards acknowledgment. Always request and keep the inspector’s business card during a visit to verify his or her identity and for future reference. What if You Fail a Site Visit? If an inspection doesn’t go well, don’t panic—but act quickly. Read the notice carefully. The MAC will detail which supplier standards you failed to meet. Common issues include an incorrect address, locked doors, or no staff present. File a Corrective Action Plan (CAP). You generally have 30 days to respond. A strong CAP should: Clearly explain how each deficiency was corrected. Include documentation (photos of signage, updated licenses, proof of staff coverage, etc.). Maintain a professional tone to show the issue was resolved. Final Thoughts PTANs may not be top of mind for most O&P providers, but they are central to Medicare enrollment—and to getting paid. Every location needs its own PTAN, every PTAN must remain active, and every site should always be inspection-ready. By keeping your PTANs current, maintaining clear documentation, and preparing staff for unannounced visits, you can prevent costly disruptions. Compliance isn’t just a Medicare requirement—it’s good business practice. If you’ve ever had questions about your PTAN or site inspections, you’re not alone. Erin Cammarata is president and owner of CBS Medical Billing and Consulting. She can be contacted at erin@cbsmedicalbilling.com . Street Sign Credit: Jim Vallee/stock.adobe.com

Medicare Enrollment: All You Need to Know

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Medicare Enrollment: All You Need to Know

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