Practice Management Alert

Follow 4 steps to ensure smooth sailing in your billing office

A new physician joins your practice, but some insurers haven't credentialed him yet, so you don't know how to bill for his services. Sound familiar? You can save yourself from last-minute scrambling and claims denials by planning ahead.

When a new physician joins your practice, you have to do more than just give your carriers the new provider's information. You also face the tricky question of how to bill for the provider's established patients who visit him at your practice, says Shannon O. Smith, CRTT, CPC, consultant auditor with Doctors Management in Knoxville, Tenn. Whether to bill these visits as new or established patients is an on-going question in the billing world, she says. Use the following four steps to achieve a seamless transition when a new physician joins your practice:

1. Update the physician's Medicare PIN information. If the provider transfers from another practice, he has most likely already established a Medicare personal identification number (PIN). But this PIN links the physician to his last practice's information, says Gustavo Lopez, business manager at Neurosurgeons of NY in White Plains, N.Y. You should fill out a CMS 855R form ("Application for Individual Health Care Practitioners to Reassign Medicare Benefits") that notifies Medicare of the physician's change in practice so the carrier can reassign the PIN to the correct information and send payments to the proper address, he says. You can find this form online at www.cms.hhs.gov/providers/enrollment/forms/.

Watch the time: Although it's simple to update a physician's PIN, the process can take up to 90 days, according to Medicare. You should initiate this process far in advance of your new physician's starting date, Lopez says. "I would recommend sending the information to Medicare at least a month-and-a-half or two months ahead of time," he says. This way, by the time the physician actually starts seeing patients, Medicare won't delay the physician's payments.

Go retro: Don't stress too much if you're unable to get your new provider credentialed with Medicare before his start date. You can place your claims on hold and file them once Medicare approves the provider's new PIN. Medicare will pay your claims retroactively to the date of the new PIN application, Smith says.

2. Inform all third-party payers about your new physician. Some carriers allow physicians to transfer their provider numbers to a new practice, while others will issue a new number, Smith says. "A new doctor just joined our practice ... and we sent out letters to each insurance carrier he participates with and updated all the records ahead of time," Lopez says. You may want to follow up with a phone call to each carrier to ensure that they've made the necessary changes in their systems, he says.

Time is of the essence: As with Medicare, many payers will take considerable time to process the new provider information - leaving you stuck with unbillable claims. And many private payers won't retroactively process your claims as Medicare will, Smith adds. The best way to avoid a billing hassle is to inform payers of the change well in advance.

Tip: If possible, try to arrange a new doctor's starting date several months after his hire date to allow your billing office sufficient time to get everything in order. "In the last practice I worked in, we hired a physician six months before his start date," and got everything done in time, Smith says.

Note on new grads: Remember that a physician who recently graduated will not have a Medicare PIN or other carrier ID numbers established. In this situation, you may need to allow yourself a little extra time to set everything up before his actual start date.

3. Establish the new physician's hospital privileges. Your new physician will require privileges at any necessary hospitals, skilled nursing facilities, surgery centers and other facilities. The privileging process is much more detailed than simply adding a new physician's name to the contract your practice already has with these entities, Smith says. A lot of hospitals require letters from the physician's medical school, diplomas, certificates, proof of continuing education units (CEUs) and more. Expect the privileging process to take up to a month, she says.

4. Bill "established patient" for the new physician's patients who follow him to your practice. Billing offices constantly face this quandary, Smith says. Billers often think they can bill a patient as "new" because the patient is new to their practice. But remember, the same physician already saw the patient - just in another location, she says.