skip to content
Thank you for visiting First Coast Service Options' Medicare provider website. This website is intended exclusively for Medicare providers and health care industry professionals to find the latest Medicare news and information affecting the provider community.
To enable us to present you with customized content that focuses on your area of interest, please select your preferences below:
Select which best describes you:
Select your location:
Select your line of business:
This website provides information and news about the Medicare program for health care professionals only. All communication and issues regarding your Medicare benefits are handled directly by Medicare and not through this website. Information for Medicare beneficiaries is only available on the medicare.gov website.
En Español
Text Size:
Close
Send a link to this page
[Multiple email adresses must be separated by a semicolon.]
Last Modified: 6/19/2018 Location: FL, PR, USVI Business: Part B

Effective date and 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.
Example:
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).
Source: The Centers for Medicare & Medicare Services (CMS) internet-only manual (IOM) publication 100-08, chapter 15, section 15.17 external pdf file
list item Please use your browser's back button to return to the referring page.
First Coast Service Options (First Coast) strives to ensure that the information available on our provider website is accurate, detailed, and current. Therefore, this is a dynamic site and its content changes daily. It is best to access the site to ensure you have the most current information rather than printing articles or forms that may become obsolete without notice.