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Medicare Participation Kit

Each year physicians have the option of modifying their status with Medicare during Medicare's open enrollment period. The decision period for physicians to change their Participation status ended Jan. 31, 2014. Because the release of the 2014 Medicare physician fee schedule was delayed this year, the deadline for physicians to change from Participating to Non-participating, or vice versa, was extended for an extra month. As the "Know your options" guide below explains, the decision to opt out of Medicare and privately contract with patients may be made throughout the year.

A 0.5 percent update to Medicare payments for three months was signed into law on Dec. 26, 2013, temporarily averting a scheduled 24 percent cut to physician payments until April 1, 2014. The AMA’s Fix Medicare Now campaign intends to use this reprieve to secure repeal of the formula that leads to this annual threat of steep pay cuts.

  • Participating (often referred to as "PAR")
  • Non-participating (referred to as "non-PAR")
  • Private contracting

Whether or not a physician is thinking about modifying their status, it is important to understand the options. Physicians can use the AMA's Medicare Participation Kit to help them evaluate their participation options and choose the direction that is suitable for their practice. The kit contains a detailed explanation of physician options, a calculator and various sample materials for communicating with patients.

Medicare Revenue Calculator

Medicare Calculator The Medicare payment calculator will help you estimate how much your total revenues from Medicare patients would change if you switch your status from Medicare participation (PAR) to non-participation (non-PAR).

Downloads

Know your options: Medicare participation guide

Medicare revenue worksheet

Frequently asked questions about Medicare participation options

CMS Medicare Participating physician or supplier agreement

CMS "Dear Doctor" letter: Announcement about Medicare participation for 2014

Sample letter to patients for practices opting out

Sample letter to patients for practices not taking new Medicare/TRICARE patients

Phone script for practices no longer accepting Medicare/TRICARE patients

Sample Medicare private contract

Sample Medicare private contract "opt-out" affidavit