Q: I want to change my Medicare participation status. When during the year can I do that and how much advance notice do I need to give?

A: It depends on your current status and what you want to change it to.

  • If you want to change from participating (PAR) to nonparticipating (non-PAR), or vice-versa, you can make that change only during the annual enrollment period, from Nov. 15 through Dec. 31 each year. The change would be effective on the first of the next year. So to switch effective Jan. 1, 2013, submit your change between Nov. 15 and Dec. 31, 2012.
    NEW: On Dec. 22, 2011, the Centers for Medicare & Medicaid Services (CMS) announced that it would extend the enrollment period -- for this year only -- through Tuesday, Feb. 14, 2012. "The effective date for any participation status change during the extension, however, remains Sun Jan 1, 2012, and will be in force for the entire year," the CMS announcement stated.
  • If you are currently non-PAR and you want to opt out of Medicare entirely, you can do that at any time by submitting an affidavit to the Medicare carrier (currently Trailblazer) within 10 days after signing your first private-pay contract with a patient.
  • If you are currently PAR, you may opt out effective the first date of each calendar quarter, i.e. Jan 1, Apr 1, July 1, Oct 1. Your opt-out affidavit must be received by the Medicare carrier at least 30 days prior to the start of the calendar quarter. A PAR physician who wants to opt-out effective April 1, 2012, must have his or her affidavit to the carrier no later than March 1, 2012.  

For more information on Medicare participation status and how to change it, listen to the recording from TMA’s Medicare experts, “Evaluating Your Medicare Options.”