Making Medicare red tape work in your favor

March 21, 2008

A physician we hired didn't work out, so we had to let him go after a few weeks. At that point, his credentialing with Medicare still wasn't complete. How can we get reimbursed for the Medicare patients he saw?

A physician we hired didn't work out, so we had to let him go after a few weeks. At that point, his credentialing with Medicare still wasn't complete. How can we get reimbursed for the Medicare patients he saw?

Wait for CMS to finish his credentialing. When they notify you that it's complete, transmit all the claims for the patients he saw, using his new Medicare provider number for the practice. As soon as you've confirmed that Medicare has received the claims and is processing them, prepare a CMS 855R form, terminating his reassignment of benefits to the group.

Some Medicare carriers will allow you to sign this form, but others require the signature of the terminated physician. You'll have to contact your carrier to find out what its policy is. But by the time you obtain the proper signature, forward the form to Medicare, and they officially terminate the reassignment, you can be reasonably sure that you'll already have received payment for the services he provided.