Q&A: CMS' rules on credentialing physicians

January 23, 2009

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.