December 4, 2012


I am adding a new doc to my practice.  Can we just start billing Medicare for their services?  How does that work?


Dr. M


Provided by Kirschenbaum & Kirschenbaum P.C. healthcare attorney Erica Youngerman, Esq.

Dr. M, I would have to know more details about your specific situation but generally speaking, there are certain forms that need to be completed prior to starting to bill Medicare for the new doctor’s services.  As a group practice, you should have already completed a cms-855B form, which is the group application for Medicare.

The new doctor must obtain or ensure that they already have an active individual Medicare number.  Be alert to the fact that even if your new doctor has been practicing for several years, she may have let her Medicare number deactivate over time.  If the doctor does not have an active number, she needs to complete the cms-855i Medicare enrollment form.

Once the individual doctor has an active Medicare number and the practice has a group number, the doctor needs to complete a cms-855r form in order to reassign his benefits to the group practice.

Of course, Medicare is not the only payor that you need to be concerned about.  Medicaid and private insurers may also have requirements regarding paperwork and proper notification that needs to be completed before they will permit you to start billing them for your new doctor.  Now is the time to consider what those requirements are so that you have the proper process in place when you bring in new doctors and don’t run the risk of violating your agreements with payors and/or having to forego payment due to improper billing.

If you need help navigating these processes, give us a call.

I would like to thank Jackie Thelian of Medco Consultants for providing insight on this topic.  Jackie is an invaluable resource of coding information.  To attend one of Jackie's seminars or to view her website and to learn more about her services, visit