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Ophthalmology and Optometry Coding Alert

News You Can Use:

Say Goodbye to the 2+ Year Credentialing Period

Published on Mon Feb 23, 2009

CMS institutes 30-day billing window, effective Jan. 1.

You're about to lose 26 months of billing privileges, effective Jan. 1.

According to the 2009 Medicare Physician Fee Schedule, you'll be able to retroactively bill Medicare for services your physician rendered up to 30 days prior to the date he received his Medicare credentialing status. Medicare will consider the physician's effective credentialing date as the "date of filing," according to the Fee Schedule -- meaning "the date that the Medicare FFS [fee-for-service] contractor received a signed provider enrollment application that the Medicare FFS contractor is able to process to approval" (emphasis added).

So make sure the application is complete, and submit any additional information the contractor requires for enrollment.

Approval Is a 'Guessing Game'

That's a huge difference from the current rules, which give you a full 27-month window during which you can retroactively bill. Despite several comments from medical practitioners requesting more than the allotted 30 days, CMS stood firm in its decision.

For example: Suppose your practice hires a new ophthalmologist 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.

Outcome: 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.

"You can no longer just bill Medicare while waiting for your credentialing approval, unless the services were performed 30 days prior to the Medicare approval," says Barbara J. Cobuzzi, MBA, CPC-OTO, CPC-H, CPCP, CPC-I, CHCC, president of CRN Healthcare Solutions. "And you have no way of knowing when your approval will happen; it's a guessing game."

PECOS May Cut Enrollment Time

Fast forward: 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, says Quinten A. Buechner, M.S., M.Div., CPC, ACS-FP/GI/PEDS, PCS, CCP, CMSCS, with ProActive Consultants. "But don't get excited if you can't. Keep trying," he advises. CMS says PECOS cuts enrollment time to half of what it was with paper enrollment.

To learn more, visit www.cms.hhs.gov/MedicareProviderSupEnroll/02_Internet-basedPECOS.asp.

 

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