Many providers call me to ask how long it takes to become credentialed with Medicare. The problem is the process can vary based on a lot of things. For one, it varies from carrier to carrier. Each Medicare region has a different carrier and those carriers can switch if the contract gets awarded to a different carrier.
Our area, upstate NY had the same carrier for over 14 years and credentialing only took about six weeks. But on September 1st, 2008 the carrier changed and now credentialing takes more like 10 weeks. Part of that is due to the transition.
There is no way to give an exact time on how long it will take, but one thing that greatly affects the time is if the correct forms are filled out right the first time. If the correct form isn’t used then the form will be returned to the provider that is applying and they have to start from scratch. It could take them up to 120 days just to return the form so four months was wasted on nothing.
If the correct form is used but it is not completed correctly then they have up to 120 days to request the corrections. They usually allow 30 days for the corrections to be submitted. Once they receive them the clock starts over. If you are applying to Medicare and you want it done quickly you need to make sure you complete the correct form and complete it right. For more information on which form you need and how to complete it correctly visit http://www.medicalbillinglive.com/medicare-credentialing.shtml .
The good news is that when you complete the form you tell them when you wish to have your participation to start. So if you are submitting a credentialing application in December to begin seeing patients in January, but they don’t approve you until March, the participation date is still for January. That means that you can see patients but you must hold the billing until the application is completed. So at least you can treat the patients and you will be paid, you just have to wait for the process to complete.
There is no way to ever be sure the form is completed 100% correctly but if the person completing it has experience with these CMS forms it is more likely to be correct on the first submission. This will cut down on the time it takes for the application to be completed.
3 comments:
Good information. But readers should also note (and be glad) that Medicare is now opening up the credentialing process for online submission. This *should* accelerate the process and *will* prevent transcription errors between the paper form and the Medicare enrollment database (PECOS). Currently available to individual providers in several states including NY, it will go nationwide soon. CMS hopes to have organizational process in place in 2009, perhaps as soon as mid-year. Read more on my blog post at http://blog.hittransition.com/2008/12/medicare-adds-online-enrollment-to-nine-more-states.html . Marty
Good information. But readers should also note (and be glad) that Medicare is now opening up the credentialing process for online submission. This *should* accelerate the process and *will* prevent transcription errors between the paper form and the Medicare enrollment database (PECOS). Currently available to individual providers in several states including NY, it will go nationwide soon. CMS hopes to have organizational process in place in 2009, perhaps as soon as mid-year. Read more on my blog post at http://blog.hittransition.com/2008/12/medicare-adds-online-enrollment-to-nine-more-states.html . Marty
Eligibility verification is the most important process in the medical billing. It involves the process of gathering information from patients at the point of care, verify patients insurance coverage and update the medical bill with eligibility details.It can help practices significantly increase their revenue by reducing the ineligibility.
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