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Billing for New Physicians

Coding Corner

The information provided here applies to Medicare coding. Be sure to check with your Medicare Administrative Contractor (MAC) for additional information and clarification on these and other items. You should also contact your local insurance carriers to determine if private insurers follow Medicare's lead on all coding matters.

Billing for New Physicians
When a new physician joins a practice, all carriers must be provided with his or her information. Medicare and Medicaid are the only carriers that permit billing and make payment retroactively. Other payers give an effective date for billing to begin. Medicare will pay claims retroactively from the date of the NPI application for the new physician. Private payers do not permit retroactive billing. Contact the carriers for instructions.

It is important to anticipate delays. Start the application process as soon as the new provider’s state licensure and DEA registration information is available, if possible at least two months ahead of the start date. This is particularly true of Medicare. Acting early will assure that the needed credentials are on hand when the new physician begins to see patients. Another challenge to be faced is proper billing for new and established patients. If a patient from the new physician’s previous practice visits him or her at the new practice, it is an established patient. Any patient that is already established at the present practice is also an established patient.