It’s Time to Pick Your Medicare Status
By Ellen Terry

 

Cleaners

For Medicare physicians, it’s annual par/nonpar decision time. 

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.

For participating physicians:  

  • 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 coverage) insurers. 

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. 

For nonparticipating physicians:  

  • 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: 


Novitas Solutions
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.

Opt-Out Option  

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 fees.
  • Once 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.

 

 

Last Updated On

December 12, 2018

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Ellen Terry

Project Manager, Client Services

(512) 370-1391

Ellen Terry has been writing, editing, and managing communication projects at TMA since 2000. She hails from Victoria, Texas; has a journalism degree from Texas State University; and loves to read great fiction. Ellen and her husband have two grown sons and a couple of cats.

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