What is retrospective billing ?

Q: What is the difference between the effective date and retrospective billing date?

A: The effective date is the later of the following two dates:
• The filing date of an enrollment application that was subsequently approved, or
• The date the provider first began furnishing services at a new practice location.
The provider may bill retrospectively 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
1. 30 days prior to their effective date if circumstances precluded enrollment in advance of providing services to Medicare beneficiaries, or
2. 90 days prior to their effective date if a presidentially-declared disaster precluded enrollment in advance of providing services to Medicare beneficiaries.
Suppose that a non-Medicare enrolled physician began furnishing services to beneficiaries at her office March 1. She submitted the CMS-855I initial enrollment application May 1, and the application was approved June 1. The physician’s effective date of enrollment would be May 1, which is the later of: (1) the date of filing, and (2) the date she began furnishing services. The retrospective billing date is April 1 (or 30 days prior to the effective date of enrollment).

Q: How do I obtain beneficiary eligibility information and/or claim status?
A: To access the status of a claim or a beneficiary's Medicare eligibility information (including the date of birth, date of death, entitlement dates, benefit dates, deductible, or coinsurance) use these options below.
Prior to providing services, obtain a copy of the beneficiary’s Medicare card and verify the beneficiary’s insurance information with either the beneficiary or his/her legal representative.

Part B providers
• Contact the Part B IVR at 877-847-4992.
Note: Customer service representatives cannot assist you with eligibility information and are required, by the Centers for Medicare & Medicaid Services (CMS), to refer you to the IVR.

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