Outpatient Facility Coding Alert - 2019 Issue 3
Reader Question: Find out How to Handle New Physician’s Billing Info
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Article Overview
This article addresses a common practice-management question about billing for a new physician before credentialing is complete. It explains the general timing considerations for Medicare claims, notes the role of the enrollment process and submission method, and contrasts those points with the variability seen across private payers. The piece is aimed at coding, billing, and physician practice staff who need a high-level understanding of credentialing-related billing issues.
Why This Topic Matters
Credentialing delays can affect whether services are payable and when claims may be submitted. Understanding the general framework helps practices avoid nonbillable claims and align billing workflows with payer requirements.
What You Will Learn
- How credentialing timing can affect billing eligibility for a new physician
- How Medicare timing considerations are described at a high level
- Why payer-specific policies matter for newly hired physicians
- How private payer participation timing can differ from Medicare-related handling
Who Should Read This
- Medical coders
- Medical billers
- Revenue cycle staff
- Physician practice managers
- Emergency department practice administrators
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