Next Event: What is Medicare Proposing for Outpatient Therapy in 2027
Date: August 25,2026
Medicare Enrollment Date, Effective Date and Retrospective Billing Date
In the private practice setting, a therapist must enroll in the Medicare program in order to provide and be reimbursed for outpatient therapy services that are covered by the Medicare program. The application can be completed on paper or online using the Medicare Provider Enrollment, Chain, and Ownership System (PECOS).
Once the therapists application has been approved by their Medicare Administrative Contractor, there are 3 dates they need to know. They are the:
- Enrollment date
- Effective date, and
- Retrospective billing date
But what do all these dates mean and when can the therapist begin treating Medicare beneficiaries? In this article, I will answer the following questions:
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Indirectly related question. Have you seen any information about changes in Provider based billing for OP Therapy hospital that are off site.
For original Medicare, there have been no changes to payment.
As a private practice hand therapy clinic, I am considering hiring a second OT. Does the retrospective billing apply to a new clinician applying for Medicare under an existing facility billing?
Yes