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Thread: New Physician to Group How do you Submit to Medicare???

  1. #1

    Default New Physician to Group How do you Submit to Medicare???

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    I need all the help I can get on this, we have a new physician to our cardiology group who will practice in our two locations. This new physician is not certified with Medicare yet for payment but is seeing patients. Both of our locations we have a primary physician that we use as the rendering physician and then put the new doctor in our mid level area for in house reports for us to see what he has done. Well one claim was sent to Medicare with the new doctor as rendering and Medicare is denying of course saying they do not recognize him. I don't think we should have to write off and I would think Medicare has something in place for situations like this. Can anyone tell me what they do or have done when in this situation? Thank you so much, Gail

  2. #2
    Join Date
    Apr 2007
    Location
    North Carolina
    Posts
    3,126

    Default

    Have they submitted an application to Medicare? Once the provider receives his #, he can retroactively file claims 30 days prior to his/her effective date; I wouldn't write them off...

    The individuals and organizations identified above may, however, retrospectively bill for services when:

    The supplier has met all program requirements, including state licensure requirements, and

    The services were provided at the enrolled practice location for up to—

    30 days prior to their effective date if circumstances precluded enrollment in advance of providing services to Medicare beneficiaries,

    https://www.cms.gov/MLNMattersArticl...ads/MM6310.pdf

  3. #3
    Join Date
    Apr 2007
    Location
    Evansville Indiana
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    451

    Default new physician

    What Rebecca said is correct. I do want to add that you cannot bill one physician incident to another which is what it sounds like you are doing by putting the other physician in as rendering, unless I am misunderstanding.

    LeeAnn

  4. #4

    Default

    Yes, we have an application for this doctor and are just waiting for him to be active at our location. Are you saying that as long as we have filed for his application we should still submit claims because it is within the 30 days of filing the application? We filed the application the first wk of June 2010.

  5. #5
    Join Date
    Apr 2007
    Location
    North Carolina
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    3,126

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    I would place your claims on hold. Our system allows us to place a carrier (Medicare in this case) on hold for a particular physician with a click of a key. Once the provider receives his provider number, release your claims. Medicare will (or should) begin retroactively processing those claim 30 days prior to the effective date...

  6. #6

    Default

    Sounds good, thank you!

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