Physicians must decide their level of participation in the 2011 Medicare program by Dec. 31. The decision will be binding for the entire year, unless the Centers for Medicare & Medicaid Services (CMS) reopens the enrollment period.
Physicians have three options:
- Sign a participation (PAR) agreement and accept Medicare's allowed charge as payment in full for all Medicare covered services for their Medicare patients.
- Elect nonparticipation (non-PAR), which permits physicians to make assignment decisions on a case-by-case basis and to bill patients up to the Medicare limiting charge for unassigned claims.
- Opt-out and become a private contracting physician, agreeing to bill patients directly and forego any payments from Medicare to their patients or themselves. 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 the affidavit is signed, provided the affidavit is filed within 10 days after the physician signs his or her first private contract with a Medicare beneficiary.
The Texas Medical Association cannot tell you what to do, but it is offering some help in making a decision through a record Web seminar, Evaluating Your Medicare Options, on the TMA website. The one-hour webinar, featuring TMA's in-house Medicare specialists, provides detailed information about participation options and the consequences of those choices. It also offers one hour of continuing medical education credit.
Program highlights include a review of:
- The three Medicare options,
- Medicare fee updates, and
- The ongoing problem.
CMS has posted a fact sheet online. Additional information is posted in the CMS Physician Center.
Action, Dec. 1, 2010
Last Updated On
November 30, 2010