Answer: The short answer is Yes, but there are some specifics that you need to be aware of. Retroactively billing Medicare is critical for most organizations as providers often start without having a Medicare number. This is in large part due to how long the provider enrollment process takes with Medicare. Your retroactive period begins once an application has been submitted but the application submitted must be approved. If the application is denied due to incomplete data or rejected because a provider doesn’t meet Medicare standards, you will lose the retroactive billing date and must start the application process over. This is why it’s so critical to stay on top of the Medicare enrollment process and ensure your application is processed without any issues. If mailing anything to Medicare, be sure to send certified and keep a copy of the tracking certificate.
Do I need to submit the claims with a special modifier?
Answer: No, you would submit the claims the same way you would any other time. You would code the visit the same way you would if you were already participating.
Do I have to worry about timely filing guidelines for retroactive billing?
Answer: For Medicare claims, the timely filing rules are waived during the enrollment period as they understand that the application is in process. It’s possible that you would receive a denial and need to submit documentation including your approval letter from Medicare, but this is rare. Make sure to keep copies of all approval letters and applications.
Here is an excerpt from one of the Medicare administrator websites: