It’s Medicare Participation Time for 2015

The annual Medicare participation enrollment program for calendar year 2015, now underway, runs through Dec. 31, 2014. Keep in mind that current Medicare fee schedule amounts are set through March 31, 2015; potential cuts won't happen until April 1, 2015.

What to Do
Review this overview of participating versus nonparticipating status to help decide your choice for 2015. Then, to be a participating physician: 

  • If you currently are participating, do nothing. 
  • If you are not currently a Medicare participant, complete the blank participation agreement (form CMS-460), making sure to include all of the names and identification numbers under which you bill.

To be a nonparticipating physician:

  • If you currently are not participating, do nothing. 
  • If you are currently a participant, submit a written, dated notice, postmarked before Jan. 1, 2015, that includes: 
  • Your name and National Provider Identifier, and
  • A statement indicating you are rescinding your participation agreement.

Submit the participation agreement or disenrollment to: Novitas Solutions, Provider Enrollment Services, PO Box 3095, Mechanicsburg, PA 17055-1813.

Updates and Reminders
The Centers for Medicare & Medicaid Services (CMS) included updates and reminders in its announcement of participation enrollment dates, released in November. Here are some highlights: 

  • Primary care incentives: New for 2015, Medicare will pay for the care coordination for Medicare patients with two or more chronic conditions. CMS will continue to make a 10-percent incentive payment for primary care services furnished by primary care physicians as authorized by the Affordable Care Act.
  • Medicare prescription drug (Part D) coverage: Beginning Dec. 1, 2015, physicians and others who write prescriptions for Part D drugs must be enrolled in Medicare in an approved status or have a valid record of opting out of Medicare for their prescriptions to be covered under Part D. CMS says you need to submit an enrollment application or an opt-out affidavit to Novitas by June 1, 2015, to ensure it is processed in time for Dec. 1. TMA's reimbursement specialists, however, recommended that the sooner you submit your enrollment, the better.
  • Physician Quality Reporting System (PQRS): 2015 will serve as the reporting period for the 2017 PQRS payment adjustment. Physicians who do not satisfactorily report data on quality measures in 2015 will forfeit 2 percent of their Medicare payments in 2017. More information will be available on the program website soon. You also can find tools and information on the TMA website at
  • Medicare and Medicaid EHR Incentive Programs: In 2015, physicians will report using 2014-edition certified EHRs and will use the 2014 definition of meaningful use for Stage 1 or Stage 2 as appropriate. Returning physicians will report for the entire calendar year and attest Jan. 1 through Feb. 29, 2016. Physicians attesting for the first time will report for any consecutive 90 days in the calendar year to avoid a Medicare payment penalty. First-timers are ineligible for Medicare incentives but may be eligible for a Medicaid incentive.
        Demonstration of meaningful use in 2015 will enable physicians to avoid a 3-percent payment penalty in 2017. (Those who did not successfully demonstrate meaningful use in 2014 will receive a 2-percent payment penalty in 2016.) Physicians also have the option of filing a significant hardship exception application (PDF) by July 1, 2015, to avoid the penalty in 2017. Find out more about the incentive programs on the TMA website at
  • Revalidation reminder: Over the coming months, you may receive a request from Novitas to revalidate your Medicare enrollment information. Be sure to respond within the deadlines. Failure to submit a complete revalidation application, including all supporting documents, may result in deactivation of your Medicare billing privileges. The revalidation address is: Novitas JH Provider Enrollment, PO Box 44137, Jacksonville, FL 32231.

 Revised Dec. 11, 2014 

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Last Updated On

May 13, 2016

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