The 2009 Medicare Physician Fee Schedule made some changes regarding physician enrollment. The most significant change is the elimination of retroactive billing. Prior to the 2009 changes, Medicare permitted retroactive billing for up to 27 months following the effective date of a physician’s Medicare enrollment, to allow physicians to bill for services that they provided while the application was pending. Although there were usually significant delays in physician approval, mostly due to simple time delays in a very inefficient system, that rarely reached 27 months.
The retroactive billing date has now been almost totally eliminated. Rather than 27 months, the physician is now permitted to bill as of the date of the application that was approved (which is interpreted to mean the last version of the application after any additional information submitted pursuant to CMS’s request) or the date that services are actually provided, whichever is later. There are two exceptions allowing retroactive billing for just 30 days if the application could not be submitted for some good reason and the physician satisfied all requirements or 90 days in the event of a presidential declaration of disaster.
A similar change has been made regarding the revocation of participation. In the event of certain enumerated serious events, i.e. conviction of the felony, the suspension/revocation of a license, or program debarment, in which case the billing rights are terminated immediately.
In all other termination circumstances, the physician will have 60 days to bill for services that were provided prior to the termination date, rather than the 27 months that was previously available.
Finally, physicians now must report changes in the ownership of the enrolled entity or the practice address of the enrolled entity, within 30 days of the change.
