Medicare Makes Participation Even Harder

Medicare is curtailing physicians' ability to retroactively bill for services provided while they were waiting for Medicare to enroll them or update their enrollment information, such as when they move their offices.

The Centers for Medicare & Medicaid Services (CMS) issued a new rule that no longer allows a physician to bill Medicare for services for up to 23 months prior to enrollment. Instead, CMS now says the eligibility date for billing will be "the later of the date of filing of a Medicare enrollment application that was subsequently approved by the contractor, or the date an enrolled physician… first started rendering services at a new practice location." Physicians can retroactively bill 30 days prior to their filing effective date "if circumstances precluded enrollment in advance of providing services to Medicare beneficiaries." CMS did not explain what "circumstances" would "preclude enrollment" before treating Medicare beneficiaries. The American Medical Association is seeking clarification.

The new rule was supposed to take effect Jan. 1 but was delayed until April 1 because of complaints and questions from the AMA.

"Enrollment application processing delays are contributing to serious cash flow problems for physicians, problems that have been significantly amplified by the current economic crisis," AMA Trustee William A. Dolan, MD, said in a December statement to the CMS Practicing Physicians Advisory Council. "Physicians are reporting that they are unable to secure revolving loans to help them while they await processing of their enrollment applications. As the availability of credit and revolving loans for small businesses has shrunk dramatically, there has been a pronounced increase in the number of physician practices reporting that they are unable to meet their payroll, are late on payroll taxes, cannot make timely mortgage payments, are unable to pay their liability insurance, and have had to stop paying other key bills like phone service."

Contact the TrailBlazer Health Enterprises Provider Enrollment Department at (866) 539-5596 for more information.

Last Updated On

May 13, 2016

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