Know your Medicare status Physicians have three options for participation in Medicare:
Participation (PAR) Physicians agree to provide all covered services for all Medicare Part B beneficiaries on an assigned basis and accept the Medicare-approved amount as payment in full. Physicians cannot collect from patients more than applicable deductibles and coinsurance, but they may collect for noncovered services.
Nonparticipation (non-PAR) Physicians do not enter into an agreement to accept assignment on all claims and may collect in full from patients. Medicare reimburses the beneficiary on nonassigned claims. Physicians cannot bill the patient more than the limiting charge, which is set at 115% of the Medicare-allowed amount (roughly 9 percent above PAR-approved amounts).
Opt-out Physicians privately contract in writing with Medicare patients. Physicians cannot bill Medicare, and Medicare does not pay the physician or reimburse the patient for services provided, with few excep- tions, such as emergency or urgent care situations. Physicians must complete a written afidavit for- mally opting out of Medicare. With the new Sustainable Growth Rate (SGR) repeal legislation, opt-out status continues indefinitely. Physicians no longer have to renew every two years.
July 2015 TEXAS MEDICINE 31
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