The Centers for Medicare and Medicaid Services (CMS) has extended the deadline for the 2013 Annual Participation Enrollment Program period. Eligible physicians, practitioners, and suppliers can change their Medicare participation status through Feb. 15, 2013. Participation elections and withdrawals must be post-marked on or before Feb. 15, 2013; the effective date for participation status changes elected by providers during the extension remains Jan. 1, 2013. The previous deadline was Dec. 31, 2012.
- Dermatologists who wish to maintain their current participation status (PAR or Non PAR) do not need to take any action during the annual participation enrollment period.
- If you are not currently a Medicare participant and wish to participate, complete CMS Form 460 — Medicare participation agreement and mail a copy to each Medicare contractor to which you submit Part B claims.
- If you are currently a Medicare participant and you are choosing not to participate in calendar year (CY) 2013, write to each Medicare contractor that you submit claims to and advise them of your termination effective Jan. 1, 2013.
To help ensure that AADA member physicians are making informed decisions about their contractual relationships with the Medicare program, the AADA offers the following brief overview of the various participation options that are available to physicians.
The AADA is not advising or recommending any one of the three options described, but rather wants to ensure that physician decisions about Medicare participation are made with complete information about the available options.
Physicians who want to continue their current par or non-par status do not need to do anything to maintain their status. Those who want to switch their status need to notify their contractor in a written document. Notice must be post-marked on or before Feb. 15, 2013.
There are three Medicare contractual options for physicians:
- PAR: Physicians may sign a PAR agreement and accept Medicare’s allowed charge as payment in full for all of their Medicare patients.
- Non-PAR: Physicians may elect to be a non-PAR physician, which permits them to make assignment decisions on a case-by-case basis and to bill patients for more than the Medicare allowance for unassigned claims.
- Private contract: Physicians may become private contracting physicians, agreeing to bill patients directly and forego any payments from Medicare to their patients or themselves.To become a private contractor, physicians must give 30 days notice before the first day of the quarter the contract takes effect.
Regardless of the participation change deadline date, a physician's participation decision will be retroactive to Jan. 1, 2013. Unless CMS reopens the enrollment period, the decision is binding throughout the calendar year except where the physician’s practice situation has changed significantly, such as relocation to a different geographic area or a different group practice.
Those considering a change in status should first determine that they are not bound by any contractual arrangements with hospitals, health plans or other entities that require them to be PAR physicians. In addition, some states have enacted laws that prohibit physicians from balance billing their patients.