Pathology/Lab Coding Alert

Question: We-re adding a new pathologist to our practice who is not yet credentialed with any of our participating Medicare contractors. Can we bill for his services before he's credentialed, and if so, what do we need to indicate on the claims?

Tennessee Subscriber

Answer: The 2009 Medicare Physician Fee Schedule final rule dramatically changes how you can bill when you-re waiting for your physician to acquire Medicare credentialing status.

Currently, practitioners can retroactively bill the Medicare program for services that they rendered up to 27 months prior to being enrolled to participate in the Medicare program. But in the future, that 27-month period shrinks down to a 30-day window, according to the final rule.

If you also bill private payers as secondary insurers, check with the individual payer. Some non-Medicare payers may give you an effective date for when you can start billing. Most payers will not take claims from dates of service prior to the date when they approved the physician as a credentialed, paneled participating physician with their particular plan.

Remember: You cannot bill services under another provider while you-re waiting for the new physician's credentialing completion.

Reader Questions and You Be the Coder were prepared with the assistance of William Dettwyler, MT-AMT, president of Codus Medicus, a laboratory coding consulting firm in Salem, Ore.