Medicare has come out with changes to the provider enrollment rules for 2009. They will no longer back date as far back on new applications. The effective date of enrollment in 2009 will be determined by the later of:
- Date of the application filing (date is defined as the date when contractor receives a signed application that the contractor is able to process to approval) OR
- Date an enrolled supplier first started rendering services at a new practice location, whichever is later.
The following is an example of the new rule:
You started rendering services February 1, 2009 but did not immediately file. Your signed Medicare application was not received until April 1, 2009. The enrollment process was completed on June 1, 2009. Your effective date is therefore April 1, 2009. As we understand it, you should be allowed to bill for 30 days retroactive (prior to your effective date) so you could submit charges with a date of service beginning March 2, 2009. Any charges prior to that will not be processed.
It is very important that you notify us as soon as you know a provider is joining your group. We are allowed to submit them up to 30 calendar days before the providers starting date. Any sooner then that and they will be returned.
Previously we had 60 days to correct an application and signature page to Medicare once they advised of a delinquency with the application. This time has been reduced to 30 days. It is very important to promptly correct and return any corrections in order to meet these more stringent deadlines.
As of 2009, providers are now obligated to report any changes in enrollment information within 90 days. With the exception of a change in ownership or control, location changes, or adverse legal actions, these must be reported in 30 days. Failure to report changes carries risk of deactivation, revocation of billing number(s), or returning payment previously made. REVOCATION IS FOR A MINIMUM OF ONE YEAR!
Effective June 2006 re-validation of enrollment information was introduced and is required every five years for all providers. The intermediary can do non-routine revalidation at any time. Failure to comply could result in the deactivation of a provider’s number. Re-validation must be completed within 60 days. Carriers have the discretion to not allow reapplication and reinstatement for up to one year.
Re-validation requests are mailed directly to the provider’s correspondence address on file. It is very important to make sure they have your current address. It is also very important for you to get us the application so we can complete it, secure signatures and return it to the carrier within 60 days from the date on the notice.
Thank you so much for your help. If you have any questions please feel free to contact me at 316-281-3701 or Sheila Burns in Provider Relations at 316-281-3716.
abinsights Contact Information
abinsights readers are invited to submit comments, questions, tips, and suggestions for articles on any subject related to billing, collections, coding, reimbursement, and compliance. Send to: Anesthesia Billing, Inc., P O Box 388, Newton, KS 67114-0388. Phone 316-281-3700. Fax 316-282-4322.
Our purpose is to help you meet inevitable challenges. We hope to deliver practical knowledge and solutions drawn from top resources and business publications in every issue, knowledge you can use today.
Reasonable attempts have been made to be accurate. However, medical billing, collections, coding and compliance are part science, part art, and even experts sometimes differ. Neither Anesthesia Billing, Inc., the editors, publisher, contributors, or consultants warrant or guarantee the information contained will be applicable or appropriate in all situations. For information specific to your practice, consult a qualified professional.
The information included in this publication is provided, among other things, to alert you to legal developments and should not be considered legal advice. Specific questions about how this information affects your particular situation should be addressed to your attorney.
Editor: Philip Blann (pblann@anesthesiabilling.com).
No Comments