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: 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:

There is much misinformation being shared regarding Medicare beneficiaries and the ability of therapists in private practice to collect cash from a Medicare beneficiary for outpatient therapy services. In this article, I will answer the following questions:

The Centers for Medicare and Medicaid Services (CMS) has revised the 855I Form for Medicare enrollment. In this article, I will answer the following questions:

I am often asked must physical therapists (PTs), occupational therapists (OTs), and speech-language pathologists (SLPs) in private practice enroll in the Medicare program if they want to treat Medicare beneficiaries for outpatient therapy services that are covered by the Medicare program? This then leads to a second question I am often asked. If PTs, OT’s and SLPs must enroll in the Medicare program, what is this non-participating provider status? Doesn’t this mean I don’t participate with Medicare, hence, I can charge the Medicare beneficiary cash for outpatient therapy services? How about services that are statutorily non-covered by the Medicare program;

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. Question How is the effective date determined? Answer QuestionWhat are the retrospective billing requirements and limitations? Answer QuestionCan you give an example of the difference between Effective Date of Enrollment and Retrospective Billing Date?