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Why does it take Medicare up to 3 months to process claims after an address change or medical billing changes?

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Author Topic: Billing for Medicare  (Read 3475 times)

ramsey825

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Billing for Medicare
« on: November 16, 2010, 09:01:10 AM »
I am in the process of starting my own medical billing company.  I currently work in a physicians office and when we changed addresses and billing companies it took atleast 3 months for medicare to start paying claims again.  I have heard this from other billing agencies as well.  I can understand taking a little longer since we changed our address but why does it take so long if you just change billing companies?

DMK

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Re: Billing for Medicare
« Reply #1 on: November 16, 2010, 10:30:40 AM »
That's government efficiency for you!  We changed 1 line of our address and it took 9 months! 

I wish I had a good explanation for the length of time it takes, but I just kept telling me it's because it's one agency handling any and all changes to all Medicare providers across the nation.  That's a lot!  Factor in address changes, bank changes (for ERA's), billing company changes, practice changes (individuals to groups and groups to individuals) and it adds up to a lot of changes to process.  Also, if a certain amount of time has passed, and you make a change, you have to re-credential.  Any errors to the paperwork and it all gets sent back to the provider.

It's inefficient, but think of all the interest they accrue from not paying the providers in the interim!  (Sarcasm)

I often wish we billers had the job of processing government paperwork, we could get the country back on its feet and rolling in no time since we are all efficient!!!

ramsey825

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Re: Billing for Medicare
« Reply #2 on: November 16, 2010, 10:46:39 AM »
I don't understand it either.  Why do they care who is submitting the billing as long as they have the physicians address why does it matter who submits the bill?  Crazy.  Thanks for feeling my pain. 

Michele

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Re: Billing for Medicare
« Reply #3 on: November 16, 2010, 12:18:21 PM »
If you are just changing billing services it should not take 3 months.  The EDI paperwork usually only takes 7-10 days (usually less).  Billing can be done as long as the paperwork to notify Medicare of the billing service change is submitted within 30 days.  You don't have to wait to bill until the CMS application is finished.

Michele
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ramsey825

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Re: Billing for Medicare
« Reply #4 on: November 16, 2010, 12:46:29 PM »
I know that the physician I work for told me that he does not want to change billing companies because it takes medicare atleast 3 months to start paying claims again.  Not sure where this info comes from but that would definately make it much harder to recruit new physicians to my billing company. 7-10 days  seems more reasonable.

ramsey825

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Re: Billing for Medicare
« Reply #5 on: November 16, 2010, 12:49:42 PM »
One more question.  If the physician is already enrolled in medicare, why would you need to submit another application in order to change billing companies?

Michele

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Re: Billing for Medicare
« Reply #6 on: November 16, 2010, 06:34:19 PM »
You are supposed to notify Medicare of all changes, including billing services.  Most people don't do that, but it is what you are supposed to do.  But it doesn't have to be done before billing can begin.  The only paperwork that must be done to bill is EDI, and that is not involved.  NY only takes about 5-7 days.
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jcbilling

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Re: Billing for Medicare
« Reply #7 on: November 16, 2010, 07:27:42 PM »
The EDI paperwork is to change clearinghouses - here in TN, it took about 4 weeks for Medicare to process. The CMS 855B / I (depending on group or individual) is the form for notifying Medicare that the provider will be utilizing a billing company. I agree with Michele - you can submit claims and get paid while that application is being procesed.

HTH,
Charity

ramsey825

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Re: Billing for Medicare
« Reply #8 on: November 17, 2010, 09:18:01 AM »
Thanks for all of the info you guys have given me.  This helps me understand the process much better.  You have been very helpful!

Thanks again
Amy ;D

Brenda09

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Re: Billing for Medicare
« Reply #9 on: November 19, 2010, 08:17:13 AM »
Hello Everyone,

Want to make sure I have this right.
EDI is for the clearinghouse information, but the medical billing company must get added to the providers CMS 855I even if there is a clearinghouse?

Thank you to all of you on this forum for your help.
Brenda

Michele

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Re: Billing for Medicare
« Reply #10 on: November 19, 2010, 01:34:29 PM »
Yes, EDI is the clearinghouse paperwork, and yes, you are supposed to use the CMS 855I to report a new billing service whether or not a clearinghouse is involved.

Michele
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Brenda09

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Re: Billing for Medicare
« Reply #11 on: November 24, 2010, 09:41:48 AM »
Is there paper work the billing service must file with Medicaid also? I called the Medicaid office and they told me only the clearinghouse had to submit paper work. I just want to double check.

Thanks,
Brenda

Michele

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Re: Billing for Medicare
« Reply #12 on: November 24, 2010, 01:13:01 PM »
Depends on the state.  NY requires paperwork for submitting claims on behalf of a provider.

Michele
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Brenda09

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Re: Billing for Medicare
« Reply #13 on: November 24, 2010, 01:37:43 PM »
Thanks. I am in CT.

Brenda