When a physical therapist, occupational therapist or speech-language pathologist in private practice enrolls in the Medicare program, how does the Centers for Medicare and Medicaid Services (CMS) determine the effective date of enrollment and what are the requirements for retrospective billing and how many days can you bill for services prior to the effective date of your enrollment? In this article, I will answer these questions.
How is the effective date determined?
What are the retrospective billing requirements and limitations?
A physical therapist, occupational therapist or speech-language pathologist may retrospectively bill for services when:
• The supplier has met all program requirements, including state licensure requirements, and
• The services were provided at the enrolled practice location for up to—
- 30 days prior to their effective date if circumstances precluded enrollment in advance of
providing services to Medicare beneficiaries, or
- 90 days prior to their effective date if a Presidentially-declared disaster under the Robert T.
Stafford Disaster Relief and Emergency Assistance Act, 42 U.S.C. §§5121-5206
(Stafford Act) precluded enrollment in advance of providing services to Medicare beneficiaries.[/restrict]
Can you give an example of the difference between Effective Date of Enrollment and Retrospective Billing Date?
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