Medicare has revised the rules regarding provider enrollment and the effective date for Medicare billing privileges. Until recently, providers were permitted to bill Medicare for claims on services provided up to one year prior to the date of their enrollment application. Such "retrospective billing" or "back billing" is now prohibited unless you fit one of two narrow exceptions. As of April 1, 2009, a provider's effective date for Medicare billing privileges is the later of either: (1) the date a Medicare enrollment application is filed; or (2) the date a provider begins to furnish services at a new practice location. A provider who meets all Medicare and state licensure requirements may back bill only:

  • 30 days prior to enrollment if circumstances precluded enrollment in advance of providing services to Medicare beneficiaries; or,
  • 90 days prior to enrollment if a declared disaster precluded enrollment in advance of providing services to Medicare beneficiaries.
  • To ensure payment for all services rendered, providers should plan to initiate the Medicare credentialing process weeks in advance of any new provider's first day of work