Make Medicare Participation Decision Before Dec. 31

Physicians who see Medicare patients have until Dec. 31 to make changes to their participation status for 2017. The American Medical Association has updated information describing Medicare participation options and frequently asked questions. 

Although many physicians are appropriately focused on preparing for the new Quality Payment Program (QPP) in 2017, the QPP will not affect physicians' Medicare payment rates and participation decisions until 2019. Rather, for 2017, payment adjustments will be determined by physicians' 2015 participation in the existing Medicare payment programs: the Physician Quality Reporting System, electronic health record meaningful use, and the Value-Based Modifier Program. 

Those facing penalties in 2017 due to these programs may want to review AMA's "Know Your Options" guide before the deadline.

For physicians who are considering a change in their Medicare status:   
  • 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. 14 through Dec. 31 each year. The change would be effective on the first of the next year. To switch effective Jan. 1, 2017, submit your change before Dec. 31, 2016. 
  • 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 (Novitas) 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, and Oct 1. Your opt-out affidavit must be received by the Medicare carrier at least 30 days before the start of the calendar quarter. A PAR physician who wants to opt out effective April 1, 2017, must have his or her affidavit to the carrier no later than March 1, 2017.  

Action, Dec. 15, 2016

Last Updated On

December 15, 2016

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