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New Medicare Rules: Signatures Now Time Sensitive

July 7, 2009

Under the name, “Incorporation of Physician Fee Schedule Regulatory Changes,” Medicare has made a significant change in the guidelines for provider enrollment into the Medicare Program. Beginning April 1, 2009, the ability to submit applications retroactively was reduced from 27 months to 30 days. If you review the credentialing process, it is clear what the impact could be for Premier and the clinicians providing care to Medicare recipients—significant lost revenue for providers who do not file applications in a timely manner.

The credentialing process begins with a provider joining a new group or an existing provider pulling shifts at another location. Individual Medicare provider numbers (PTAN) must be obtained for every site a provider works; it does not remain the same from site to site. Medicare, as well as other payers, requires a completed application, documentation related to provider education, licenses and NPI validity and the provider and Premier authorized official signature. Medicare must receive this information thirty days prior to the first date the provider provides care. If this completed application arrives after the provider begins giving care, Medicare will not pay the submitted claims, hence free care.

How can you help? It is imperative that you review and complete the payer applications as soon as you receive them. The MBI credentialing department strives to make this task as easy as possible. The application is completed as much as possible with the information you have provided to Premier. It is also marked to indicate questions the provider must complete and sections requiring signatures (must be in blue ink). A return, postage paid envelope is included for easy return. The MBI credentialing department will send an email or will call to advise that a packet is in the mail.

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