Part B Insider (Multispecialty) Coding Alert

Published on Tue Nov 11, 2008 PDF

CMS will institute 30-day billing window as of Jan. 1.

You're about to lose 26 months of billing privileges, effective Jan. 1.

According to the 2009 Medicare Physician Fee Schedule, you'll be able to retroactively bill Medicare for services your physician rendered up to 30 days prior to the date he received his Medicare credential-ing status.

That's a huge difference from the current rules, which give you a full 27-month window during which you can retroactively bill. Despite several comments from medical practitioners requesting more than the allotted 30 days, CMS stood firm in its decision.

For example: Suppose you hire a new physician who recently applied for Medicare status but has not yet received his credentials. He sees several patients each day over a three-month period, at the end of which he receives his credentials.

Outcome: You'll only be able to retroactively bill for the work the physician performed during the final 30 days prior to his credentialing. The other two months of work will not be billable.

"You can no longer just bill Medicare while waiting for your credentialing approval, unless the services were performed 30 days prior to the Medicare approval,"  says Barbara J. Cobuzzi, MBA, CPC-OTO, CPC-H, CPC-P, CPC-I, CHCC, president of CRN Health-care Solutions. "And you have no way of knowing when your approval will happen; it's a guessing game."

Fast forward: If you've seen credentialing drag on for months, you may benefit from a new government program.

You may be able to speed up your credentialing by using the PECOS system, says Quinten A. Buechner, M.S., M.Div., CPC, ACS-FP/GI/PEDS, PCS, CCP, CMSCS, with ProActive Consul-tants. "But don't get excited if you can't. Keep trying, as it will be in place by Dec. 31," he advises.

PECOS is currently established in 24 states, and CMS says it cuts enrollment time to half of what it was with paper enrollment.

To review the fee schedule and learn how to submit comments, visit the CMS Web site at www.cms.hhs.gov/physicianfeesched/downloads/CMS-1403-FC.pdf?agree=yes&next=Accept.