Are You Going to Stay in Medicare?

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:

  1. Sign a participation (PAR) agreement and accept Medicare's allowed charge as payment in full for all Medicare covered services for their Medicare patients.
  2. 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.
  3. 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

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