CMS Announces They Will Push Back the Deadline for 2010 Medicare Participation Decisions

The Centers for Medicare and Medicaid Services (CMS) recently announced that they would push back the deadline for 2010 Medicare participation decisions. Physicians who wish to change their participation status for 2010 now have until January 31, 2010, to do so. The effective date of the decision will be January 1, 2010, retroactively if necessary. Participation decisions are binding for one year, unless physicians choose to opt out entirely. Once physicians opt out, they cannot opt back in for two years.

As you know, the 2010 Medicare Physician Fee Schedule recently published by CMS contains a 21.2% payment cut. CMA continues to work on passing a permanent SGR fix before the end of the year as part of the health reform package.

Physicians, as always, have three choices regarding Medicare:

• Be a Participating Provider: A participating physician must accept Medicare-allowed charges as payment in full for all Medicare patients.
• Be a Nonparticipating Provider: A nonparticipating provider can choose to accept or not accept assignment on Medicare claims on a claim-by-claim basis. Nonparticipating physician fees are 95% of participating physician fees. If you choose not to accept assignment, you can charge the patient 9.25% more than the amounts allowed in the participating physician fee schedule.
• Opt out of Medicare Entirely: Physicians who opt out of Medicare are bound only by their private contracts with their patients. Medicare's limiting charges do not apply to these contracts, but Medicare does specify that these contracts contain certain terms. When a physician enters into a private contract with a Medicare beneficiary, both the physician and patient agree not to bill Medicare for services provided under the contract.

For more information on physicians' Medicare participation options, see CMA ON-CALL document #0151, "Medicare Participation (and Nonparticipation) Options."