For Medicare physicians, it’s annual par/nonpar decision
That is, you have until Dec. 31 to change your status as
a participating (par) or nonparticipating (nonpar) physician in the Medicare
program, starting Jan. 1. If you decide to continue with your current status,
do nothing. If you want to change your status, you’ll need to notify Novitas
Solutions by mail.
Or, you can opt out of Medicare altogether.
In making your decision, it helps to know what’s new for
Medicare in 2019. In the Texas Medical Association’s new on-demand webinar, Medicare
2019 Update Part 1: Fee Schedule Changes, Genevieve Davis, TMA’s
associate vice president for payment advocacy, explains the changes, Medicare
participation, and more. The webinar is free for TMA members thanks to a generous contribution from the TMA Insurance Trust.
Here is a quick run-down of the differences between par
and nonpar status.
- Medicare payments are 5 percent higher than for nonpar physicians.
- Medicare pays you directly because the claims are always assigned.
- Claim information is forwarded to Medigap (Medicare supplemental
To become a participating physician, complete the CMS-460 — Medicare Participating Physician or Supplier
Agreement and mail it to Novitas Solutions at the address below.
When filling out the form, be sure to include all of the names and
identification numbers under which you bill.
- Medicare payment is 5 percent lower than for par physicians.
- You cannot charge the beneficiary more than the limiting charge, a maximum of 115 percent of the Medicare
Physician Fee Schedule amount.
- You may accept assignment on a case-by-case basis.
- You have limited rights to appeal a coverage or payment decision.
To switch from par to nonpar status, submit a written, dated
notice with your name and National Provider Identifier, and a statement
indicating you are rescinding your participation agreement. This must be
postmarked before Jan. 1 and sent to Novitas at the mailing address below:
Provider Enrollment Services
PO Box 3095,
Mechanicsburg, PA 17055-1813
Find more information
about par/nonpar status on the Novitas website. Visit the TMA website
for information about changes in the Medicare Physician Fee Schedule for 2019.
You can decline to participate in Medicare altogether. If
you opt out, you cannot file claims with Medicare, nor can a patient covered by
Medicare file claims for your services and treatments.
- You must sign a contract with the patient stating
the patient will pay out of pocket for services and treatment, at your standard
you’ve opted out of Medicare, you cannot submit claims to Medicare for any of
your patients for two years.
To opt out, you
must file an affidavit with Novitas. The opt-out automatically renews after two
years unless you notify Novitas 30 days before the start of the next two-year
period. See the Novitas
website for more information.
Reminder: Report Changes in Ownership
Be sure to update
your Medicare enrollment information to reflect any changes in practice ownership
within 30 days of the change. Owners are individuals or corporations with a 5-percent
or greater ownership or controlling interest. You could lose your Medicare
billing privileges if you don’t report an ownership change. Update ownership
information in the Medicare Provider Enrollment, Chain, and Ownership System
(PECOS); for help see the PECOS tutorial for individual
physicians or PECOS tutorial for organizations.