New Deadline for Medicare Participation Status Changes Is Jan. 31

January 07, 2014 04:27 pm News Staff

As family physicians plunge into a new year, a deadline reminder is in order: Physicians have until Jan. 31 to change their Medicare participation status for 2014.

According to a Nov. 27 special edition of CMS' MLN Connects(www.google.com), the agency extended the annual physician participation enrollment period beyond the customary date "due to the later than usual release of the Medicare Physician Fee Schedule Final Rule."

CMS said participation elections and withdrawals must be postmarked on or before Jan. 31. However, the effective date for any participation status change is Jan. 1.

The AAFP, in tandem with the AMA, has made resources available to members to help them sort through their Medicare options. Physicians can choose to

  • sign a participation agreement and accept Medicare's allowed charge as "payment in full" when billing for services provided to Medicare patients;
  • elect to become a nonparticipating physician and make assignment decisions on an individual basis and, thereby, retain the right to bill patients for more than the Medicare allowance for unassigned claims in a process called "balance billing"; or
  • become a private contracting physician, agree to bill patients directly and forgo any payments from Medicare.

As pointed out in a Dec. 23 entry in Family Practice Management's Getting Paid blog, physicians should carefully consider their options because participation decisions are binding for the entire year.

In addition, the AAFP is reminding physicians considering a Medicare status change to ensure that they are not bound by any contractual agreements already in force with hospitals, health plans or other entities that would require a physician to participate in Medicare. Furthermore, physicians should be aware that some states do not allow physicians to engage in balance billing for services provided to patients.

The resources available from the AAFP include a link to the AMA's Medicare participation kit, an example of how payment for a specific service provided to a patient would be paid according to each of the three options, and downloadable samples of a private contract and an "opt-out" affidavit.


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