Practice Management Alert

Question: One of our physicians is not yet credentialed with Medicare, and we have a Medicare patient who needs surgery and doesn't want to wait. If this physician performs the surgery, how should we go about billing for the service?


Nebraska Subscriber


Answer: If the patient is willing, you could of course take the private pay route. However, Medicare will allow you to place your physician's claims on hold and then file them once he receives his credentialing. You can actually do this for all your physician's Medicare services while he remains without credentials. Medicare will pay your claims retroactively to the date of the physician's new PIN application.

You should contact your carrier for details on how to do this. Try this: In the future, you may want to allow your office more time when trying to credential a new physician. Although credentialing the physician is simple, the process can take up to 90 days, according to Medicare. Experts recommend that you initiate this process far in advance of your new physician's starting date - two months ahead of time, if not more.  If you act early, you'll have the necessary credentials in place when the physician starts seeing patients and you won't have to hassle with delayed Medicare payments.