Medicare in 2013: Are You In or Out?

You have a month to decide if you will participate in Medicare this year. Feb. 15 is the deadline to make a decision. The Texas Medical Association will help you decide with a new webinar discussing your three options.   

The Centers for Medicare & Medicaid Services extended the deadline earlier this month 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 payment to physicians and froze fees through Dec. 31, 2013.

Your three options in deciding whether to participate in 2013 are:

  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 the affidavit is signed, provided it is filed 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 a physician must file if he or she decides to opt out. 


Action, Jan. 15, 2013