Time to Decide About Medicare

Time is running out to decide if you will participate in Medicare this year. Feb.15 is the deadline to make a decision. TMA will help you decide with a new webinar discussing your three options.

Novitas Solutions, the Texas Medicare administrator, posted the 2013 Texas fee schedule on its website.

The Centers for Medicare & Medicaid Services extended the deadline in January after Congress passed and President Obama signed last-minute legislation to avert the so-called "fiscal cliff." Part of the deal stopped the scheduled 28.5-percent cut in Medicare payments to physicians, freezing fees through Dec. 31, 2013.

If you currently are participating or not participating and want to stay that way, you do not have to do anything. Otherwise, you have three options in deciding whether to participate in 2013:

  1. Sign a participation (PAR) agreement and accept Medicare's allowed charge as payment in full for all Medicare covered services for your Medicare patients.
  2. Elect nonparticipation (non-PAR), which permits you to make assignment decisions on a case-by-case basis and to bill patients up to the Medicare limiting charge for unassigned claims.
  3. Opt out and become a private contracting physician, agreeing to bill patients directly and forego any payments from Medicare. To become a private contractor, PAR physicians must give 30 days' notice before the first day of the quarter the contract takes effect. For non-PAR physicians, the opt-out effective date is the date you sign the affidavit, provided you file it within 10 days after you sign your first private contract with a Medicare beneficiary.

Novitas has several resources on its website. They include an overview of Medicare assignment, participation, and the opt-out process. A separate page on the Novitas website offers more detailed information on the opt-out process. The page also includes a sample affidavit you must file if you decide to opt out.


Action, Feb. 1, 2013


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