Reader Question: Master New Physician Billing With These Tips

Why This Topic Matters

Practices often need to decide whether services performed before credentialing can be billed, and the answer can vary by payer and by the timing of the enrollment process. Understanding these general rules helps billing staff and administrators avoid claim denials and coordinate provider onboarding more effectively.

Article Sections

1. Question

   The reader asks about billing for services provided by a newly started physician before insurance credentialing is complete.

2. Answer

   The response outlines the general billing issue and emphasizes that payer policies differ, especially between Medicare and private plans.

3. Medicare timing and retroactive billing

   This section discusses Medicare-related billing timing, including retroactive billing concepts and the effect of enrollment status and application timing.

4. Nuts and bolts

   An example is used to illustrate how credentialing timing can affect which services may be billed.

5. CMS provides this example

   The article includes a CMS-based scenario showing how effective dates may relate to the receipt date of an application.

6. Private payer difference

   This section notes that commercial payer rules vary and that practices should confirm each payer's credentialing and billing policies.