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

  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
    North Carolina
    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 toβ€”
    30 days prior to their effective date if circumstances precluded enrollment in advance of providing services to Medicare beneficiaries,
    Rebecca CPC, CPMA, CEMC

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  3. #3
    Evansville Indiana
    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.


  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
    North Carolina
    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...
    Rebecca CPC, CPMA, CEMC

    Your click COUNTS...

    CLICK to give FREE mammograms!

  6. Default
    Sounds good, thank you!

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