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  • Dec. 31 Deadline to Change Medicare Participation Status

    Physicians who choose to change their participation status with Medicare must do so before Dec. 31. If you do not want to change your status, you do not need to do anything.

    As a reminder, you have three options for participation with Medicare Part B:

    1. Participation: You accept assignment for Medicare’s allowed amount. Contractors process electronic claims within 14 days and automatically send them to participating secondary payers.
    2. Non-participation: Under this enrollment option, you can choose to accept assignment on a case-by-case basis. By accepting assignment, physicians agree to the fee schedule’s limiting charge. Patients pay the limiting charge at the time of the service and then Medicare reimburses them. If you do not accept assignment, the maximum amount you may charge a patient is 115 percent of the approved fee schedule, which is at 95 percent of the participating physician fee schedule.
    3. Opt-out: Neither you nor your patients can submit a claim to Medicare. Instead, the patient contracts directly with the physician. The patient must pay all charges out-of-pocket and assumes full responsibility for payment. Opting-out affects secondary payers, as they may not process the claim without a remittance advice from the primary payer. Physicians can opt out at any time, but you must have an affidavit on file. The opt-out lasts for two years at a time. Medicare will automatically re-enroll physicians with opt-out status unless you notify them 30 days before the start of the new two-year period.

    Be sure to check your Medicare Administrative Contractor website for any additional information.