• Time for physicians to decide on 2023 Medicare contract

    Physicians have until Dec. 31 to reassess their contractual relationship with Medicare and decide how they want to participate in 2023.

    There are three Medicare contractual options. Physicians may sign a participating (PAR) agreement and accept Medicare's allowed charge as payment in full for all their Medicare patients. They may elect to be a non-PAR physician, which permits them to make assignment decisions on a case-by-case basis and bill patients for more than Medicare’s allowed charge for unassigned claims. Or they may become a private contracting physician, agreeing to bill patients directly and forego any Medicare payments.

    If you want to maintain your current status in 2023, you do not need to take any action. If you’re a newly enrolling Medicare physician, you can submit the agreement electronically with your enrollment application. Otherwise:

    • If you want to participate in Medicare next year, and you’re not currently participating, complete the Medicare Participating Physician or Supplier Agreement (CMS-460) and mail a copy to each Medicare administrative contractor (MAC) to which you’ll send Part B claims.
    • If you don’t want to participate in Medicare next year, and you’re currently participating, write to each MAC to which you send Part B claims and tell them you don’t want to participate effective Jan. 1, 2023. This written notice must be postmarked before Dec. 31, 2022.

    To privately contract with a Medicare beneficiary, physicians must enter into a private contract and file an affidavit that meets specific requirements. To opt out, physicians must file an affidavit that meets the necessary criteria and is received by the MAC at least 30 days before the first day of the next calendar quarter. More details on this can be found in section 40 of chapter 15 of the Medicare Benefit Policy Manual.

    For additional information on Medicare participation options in 2023, please see the related announcement on the Centers for Medicare & Medicaid Services’ website.

    — Kent Moore, AAFP Senior Strategist for Physician Payment

    Posted on Nov. 28, 2022

    Disclaimer: The opinions and views expressed here are those of the authors and do not necessarily represent or reflect the opinions and views of the American Academy of Family Physicians. This blog is not intended to provide medical, financial, or legal advice. Some payers may not agree with the advice given. This is not a substitute for current CPT and ICD-9 manuals and payer policies. All comments are moderated and will be removed if they violate our Terms of Use.