Medicare retroactive billing period reduced to 30 days

According to the 2009 Medicare Physician Fee Schedule, physicians will be able to retroactively bill Medicare for services your physician rendered up to 30 days prior to the date he or she received Medicare credentialing status. This became effective January 1, 2009. That’s a huge difference from the current rules, which give you a full 27-month window during which you can retroactively bill.

Example: Suppose you hire a new physician who recently applied for Medicare status but has not yet received his credentials. He sees several patients each day over a three-month period, at the end of which he receives his credentials. You’ll only be able to retroactively bill for the work the physician performed during the final 30 days prior to his credentialing. The other two months of work will not be billable.

We have all seen how long it takes to get an approved Medicare number. If you’ve seen credentialing drag on for months, you may benefit from a new government program. You may be able to speed up your credentialing by using the PECOS system. PECOS is currently established in 24 states, and CMS says it cuts enrollment time to half of what it was with paper enrollment.

About the Author

Reed Tinsley CPA

This article is written by Reed Tinsley, a Houston, TX-based CPA with over 30 years of experience advising physicians and medical practices across Texas and the United States. Reed holds certifications as a Certified Valuation Analyst (CVA), Certified Healthcare Business Consultant (CHBC), and Certified Financial Planner (CFP), specializing exclusively in the healthcare sector. He is a published author, nationally recognized speaker, and trusted advisor to physicians on accounting & tax, practice management, and financial planning. Schedule a Free Consultation.