New provider billing

[ugadawg]

Hi all,

 

I am a new graduate and will be starting work tomorrow. My office and I submitted my paperwork to become a medicare provider. I was wondering if anyone understands the laws and if I am allowed to see medicare patients or not. When I called medicare, they advised that I don't see medicare patients because if I get denied for some reason I would basically be seeing those patients for free. I asked about the "incident to" billing (found on AAPA website- you can bill under your supervising physician as long as you're just seeing a follow-up patient, and the medicare representative said they had never heard of this. Does anyone know if I can see medicare patients, or not? 

 

Thanks

[jmj11]

Hi all,

 

I am a new graduate and will be starting work tomorrow. My office and I submitted my paperwork to become a medicare provider. I was wondering if anyone understands the laws and if I am allowed to see medicare patients or not. When I called medicare, they advised that I don't see medicare patients because if I get denied for some reason I would basically be seeing those patients for free. I asked about the "incident to" billing (found on AAPA website- you can bill under your supervising physician as long as you're just seeing a follow-up patient, and the medicare representative said they had never heard of this. Does anyone know if I can see medicare patients, or not? 

 

Thanks

You must have an NPI number and enrolled with Medicare ( see here ). When enrolled, you can bill independently or incident to, per the protocol for each way. If you are not enrolled, and you see a medicare patient, you will be seeing them for free and it does not matter if it is independent or incident to. It is the responsibility of the practice to enroll you so that you get paid for your services. I would be a millionaire today if I had been paid for all the patients I have seen for free over the years for one reason or the other.

[ugadawg]

Haha! Thank you for the reply. We have applied for my enrollment in medicare. We were just unsure if I could see patients while we are waiting for the paperwork to go through.

[jmj11]

Haha! Thank you for the reply. We have applied for my enrollment in medicare. We were just unsure if I could see patients while we are waiting for the paperwork to go through.

Medicare will not pay a penny on claims they receive before you are enrolled. Even if you SP is enrolled and in good standing, no payments will be made on patients that you see.  Good luck.  

[EvanBurke]

I'm interested is there any options in medicare to payments in case SP is enrolled. 

[jmj11]

sorry, posted in the wrong place.

[DizzyJ]

Last I recall there was a 30 day retroactive billing period.  So, if you get credentialed June 1st, you could submit claims to be paid for 30 days prior to your enrollment date.  This may have changed, but something you could look into. 

[AshleyJackson12]

On 1/10/2017 at 8:26 AM, jmj11 said:

You must have an NPI number and enrolled with Medicare ( see here ). When enrolled, you can bill independently or incident to, per the protocol for each way. If you are not enrolled, and you see a medicare patient, you will be seeing them for free and it does not matter if it is independent or incident to. It is the responsibility of the practice to enroll you so that you get paid for your services. I would be a millionaire today if I had been paid for all the patients I have seen for free over the years for one reason or the other.

Hi,

I agree with jmj11,

You must have an NPI number to become Medicare provider. NPI is a unique identification number for covered health care providers

Thanks!!

[medwave]

Have you been credentialed as of yet? You'll need to be in your State or Commonwealth. You have to carry your State's or Commonwealth's license.

If not, I wrote up a massive Credentialing (On-Board Process for Providers, Facilities) document (which might help you), I paraphrased some of the article below:

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Credentialing for providers, large groups, or facilities can be a tedious task that can often require a team of specialists to handle all the on-boarding information as well as updates throughout the year. As of April, 2018, CMS now mandates that providers maintain accurate information and timely updates. Providers and facilities that do not keep up with these updates risk having their in-network status with the insurance company taken away as well as fines and penalties.

We have composed some of the most popular questions and concerns that your office may have in choosing someone to credential your providers. 

Questions:

1. Turn-around time – 24 hours

   1. New Provider – Using primary source verification, we are able to pull most of your provider’s information within a few hours. If more information is needed from the provider or facility then we can gather that information quickly by sending you a secure link with information needed to send back.
   2. Resolve a credentialing issue – Our credentialing applications are tailored to the insurance companies specifications. If there is wrong information or information missing then the application cannot be sent out without it being corrected. The turnaround time would be same day for us. If there was information lacking from the provider then they would get a same day email with information needed and a secure link to add the information.

2. How to send and receive applications and required documents

   1. Most of the information will be gathered via primary source verification. This is the most up to date accurate information that can be populated. In most cases it has more up to date information than what the provider has available to give us. All applications will be generated electronically and able to be signed electronically.

3. Availability for participation in our on-boarding meetings

   1. We are available 5 days a week. Monday through Friday and Saturday mornings for any conference calls. We would be happy to accommodate your requests.

4. What distinguishes us from our competitors?

   1. Primary source verification: we are alerted to any changes in the providers license, credentialing, DEA, CAQH, NPPES etc., the same day it is changed in their systems. This is usually weeks before the facility or provider is even aware anything has changed. This allows us to alert you and the provider of any credentialing, licensing, certifications, and board expiration’s that come up in a timely manner so we can correct them and keep your providers and facility in full compliance.
   2. We are able to tailor credentialing applications to the insurance companies specifications so that there is little to no denials.
   3. We have electronic signature capabilities on all credentialing applications that can be sent directly to the provider through secure email. We are also able to provide each on-boarded provider with their own credentialing secure email if your facility would like.
   4. Most everything that we do is electronic, which will eliminate most, if not all, need for paper forms or paper signature requests.
   5. Provider /Facility and its managing employees would have access to our secure software platform for you to view and print any and all provider information, licenses etc., that you may need to keep on file.
   6. We can provide you reporting on when applications have been sent, viewed by the provider, signed by the provider, accepted by the insurance company. We keep track of every email, signature, view, acceptance, denial, and more. All communication is auto-documented and made available for you and your staff to see. Transparency and communication are very important to us.
   7. We are able to integrate with CAQH so there are timely automatic updates as soon as the primary source verification has also been updated.
   8. We are available to speak with you 6 days a week.

5. Timeline to provide services from date contract is signed

   (Once a contract to provider credentialing services to your facility and providers was signed and the Excel spreadsheet was sent over with the providers information, the timeline would be as follows):

   1. Providers would be complete and added to our software within 5-8 business days.
   2. By week two you can expect the providers to be integrated with primary source verification, CAQH, NPPES, PECOS, DEA, and other licensing agencies.
   3. By week three, the credentialing contracts would be generated based on information you provide to us. E-mails would be sent to providers if more information was needed.
   4. By week four, we would like to see everything submitted and sent out electronically.

6. While we strive to keep within our timelines, we are also at the mercy of the providers responding back to us in a timely manner as well.

   1. After the first month, we would now be considered fully integrated and working on the current applications sent, maintaining provider compliance with insurance company(s), CAQH, NPPES, DEA, State Licensing.
      Ready to add more providers as needed!

Edited August 24, 2019 by medwave