The difference between modifier Q6 and modifier Q5 is whether money passes between the two physicians. Here is what CMS requires for each arrangement, the 60-day limit that applies to both, and the record an auditor asks for.
Four separate obligations keep a provider in network, and each one runs on a clock owned by somebody else. Here is what triggers each clock, and what actually happens when one lapses while the others stay current.
Four enrollment tracks, four owners, and one sequence. This is the checklist to add a provider, the order the identifiers and applications have to follow, and the money held up while each track is pending.
Credentialing approves the clinician. Contracting sets the money. Most of the questions your billing team asks live in a provider manual or a fee schedule addendum rather than in the contract, and when the contract is silent you have to ask in writing. Here is what to ask for, and what to do when no one answers.
CAQH ProView is one record that every payer you authorize reads. When the attestation behind it lapses, the file stalls quietly. Here is the cycle, the fields that break it, and the calendar habit that keeps it current.
The stages a practice really waits through, who owns each clock, and which timeline numbers payers and CMS publish versus the ones nobody owns.
Medicare revalidation is the recertification every enrolled practice has to run on a five year clock, and the due date is public. Here is how to look it up, when to file, and what a missed deadline actually does to your claims.
