PECOS: Get The Skinny On Enrollment Specifications To Avoid Giving Away Services

Why This Topic Matters

Provider enrollment timing can directly affect whether services can be billed and paid, especially when a new clinician starts before credentialing is complete. The article helps practices understand the broad compliance and operational issues involved in Medicare enrollment and related payer processes.

Article Sections

1. CMS enrollment and overpayment-related denial guidance

   Introduces a CMS update affecting enrollment applications and explains why ownership and overpayment status are relevant to practices. Sets the context for the credentialing and billing questions discussed later.

2. Can We Bill Retroactively?

   Discusses general timing considerations for billing services when a new physician is not yet credentialed. Covers Medicare versus private payer differences and the impact of electronic versus paper application filing.

3. Can We Just Use Another Provider’s NPI?

   Addresses concerns about billing under another provider identity while waiting for credentialing. Includes a discussion of temporary coverage concepts, locum tenens, and related claim-form information.

4. What is the Best Way to Ensure We Get Paid?

   Focuses on planning credentialing early enough to support a provider’s start date and avoid payment delays. Includes general operational suggestions for practices onboarding a new physician.