Q&A: CMS' rules on credentialing physicians

Article

CMS now mandates that retroactively billing for a physician in the credentialing process must be completed within 30 days.

Q: I read in a recent Coding Cues column that CMS has shortened to 30 days the period of time during which we can retroactively bill for a physician in the credentialing process. When does the time period start?

A: The 30-day period begins on the date the application is received. The Provider Enrollment Chain and Ownership System, CMS's web-based provider-enrollment system, should speed up the credentialing process, similar to what the Council for Affordable Quality Healthcare has done for other insurers. Providers can access the CMS database with their National Provider Identifier number and pass code. But the enrollment situation is complicated by CMS's instructions to contractors to deny applications that are not completed correctly, rather than rejecting them. Denied applications can be reopened only if they are appealed, and there is a limited time in which an appeal can be filed. The denial notice should indicate the time limitation and the appeal requirements. So complete applications thoroughly and submit them in a timely manner.

Related Videos
Robert E. Oshel, PhD
Gary Price, MD, MBA
Victor J. Dzau, MD, gives expert advice
Ron Holder, MHA, gives expert advice
remote patient monitoring
referral
no shows
effective meetings
phone
Related Content
© 2023 MJH Life Sciences

All rights reserved.