Part B Insider (Multispecialty) Coding Alert

Published on Tue Sep 09, 2008 PDF

Remember: Medicare credentialing can take 90 days -- or longer -- so apply quickly when a new physician comes on board.

Question: Our practice is expanding, and we will soon have two new physicians starting who are not yet credentialed with any of our participating Medicare contractors. Can we let these physicians see patients and then bill for those services? And if so, how should we submit the claims for these doctors?

Answer: The answer depends on the contractor.

Medicare will allow you to hold your physicians' claims from the date they apply for their Medicare provider numbers and then file them once the physicians receive their credentialing from Medicare. You can do this for all of your physicians' Medicare services while they remain without credentials. Medicare will pay your claims retroactively from the date of the new physician's 855 application.

If you also bill private payers as secondary insurers, check with the individual payer. Some non-Medicare payers may give you an effective date for when you can start billing. Most payers will not take claims from dates of service prior to the date when they approved the physician as a credentialed, paneled participating physician with their particular plan.

Remember: You cannot bill services under another provider while you're waiting for the new physicians' credentialing completion. There is no such thing as a physician billed "incident to" another physician.

Try this: When a patient needs to see a physician before that physician is credentialed, you can take the private-pay/non-participating route, if the patient is willing. Be sure to allow your office plenty of time when trying to credential a new physician. The process can take 90 days or even longer, according to Medicare. Experts recommend that you initiate this process as far in advance of a new physician's starting date as you can. If you can act early, you'll have the necessary credentials in place when the physician starts seeing patients, and you won't have to hassle with any type of delayed payments.