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Thread: Can my Dr bill a Medicare Managed Care Plan?

  1. #1

    Question Can my Dr bill a Medicare Managed Care Plan?

    AAPC: Back to School
    We added a new MD to our group and he was not previously enrolled in Medicare. We have started the process of enrolling him in Medicare (months ago) with our group. We our a hospital based pathology group and we are not in network with any Medicare Managed Care Plan. We still receive payment because the hospital is in network. Can our new Dr bill charges to a Medicare Managed Care Plan even though he is not enrolled with Medicare?

    Thank you,

  2. #2


    I'm not 100%, but for these types of plans, when you don't participate, when you agree to see that patient, you are also "agreeing to abide by Medicares terms" (or whatever that lingo is) Since you aren't par yet, I would say to wait and you should be able to retroactively bill. You should have also put an effective date on the 855 apps so your doc can retro bill for his normal Medicare patients. Just my 2 cents, but your best bet is to contact them

  3. #3


    sounds like to me you have a "group/facility" contract with managed medicare. Your guys are "added" on to the hospitals contract as participating. Now you have a new guy.......i assume he is going to be added on to the same "hospital/group contract and will be participating eventually? I would hold all his medicare claims. On the credentialing aspect of the Medicare application you would need to make sure you ahve the "effective" date the earliest date he started seeing medicare patients at your facility?

    Unless because it is "managed" they do not go retro.......

    you need to make a phone call to "contracting dept" at this HMO medicare and ask the questions. I bet you have a "group/facilty contract and you'll be fine.....but you need to find out.

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