2013 Medicare Participation Deadline Extended

Physicians now have until Feb. 15 to decide whether to participate in the Medicare program this year, the Centers for Medicare & Medicaid Services (CMS) announced Jan. 3. The announcement follows Congress' New Year's Day decision to freeze Medicare payments to physicians through Dec. 31 as part of the legislation to avoid the so-called "fiscal cliff." Physician payments were scheduled to plummet almost 30 percent.

Physicians 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 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 to 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 it is filed within 10 days after the physician signs his or her first private contract with a Medicare beneficiary.

Novitas Solutions 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 a physician must file if he or she decides to opt out.

Participating physicians should file claims using their standard charge. That will allow Novitas to pay you correctly, as soon as CMS calculates the new fee schedule. 

TMA is preparing a new webinar discussing the details of the three Medicare options. A link to the webinar will be posted in the TMA Education Center. More information will be available in future issues of Action.

The fiscal cliff agreement – which President Obama signed Jan. 2 – replaces the 26.5-percent Medicare physician payment cut with a "zero-percent update" to the Medicare physician fee schedule conversion factor for 2013. This does not mean that fees are the same as last year because conversion factor adjustments and relative value unit (RVU) changes contained in the final fee schedule rule for 2013 may result in payment rate changes. The deal also postpones for two months the additional 2-percent Medicare cut that was part of automatic, across-the-board cuts in federal spending.

In addition, Congress preserved the higher Medicaid payments for primary care services, as requested by the Texas Medical Association and other state and national medical societies. The geographic work adjustment (1.0 floor) was extended through Dec. 31, 2013. However, the Medicare Part B equipment utilization assumption for advanced imaging services was raised to 90 percent, effective for fee schedules established for 2014 and subsequent years, thus reducing future payment.

The $25 billion cost of the freeze is paid for by cuts in Medicare payments to hospitals, pharmacies, and end-stage renal disease treatment.

Congress did not address organized medicine's top priority: repeal of the Sustainable Growth Rate formula that forces the annual crisis in payments for Texas physicians who care for 2.8 million Medicare patients and more than 870,000 military families who receive coverage through TRICARE.

Action, Jan. 4, 2013