Medicare Participation Kit

Each year physicians have the option of modifying their status with Medicare during Medicare's open enrollment period, which has started. Physicians have three options for participation

• 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.

Due to the passage of legislation by Congress on New Year’s Day averting the scheduled cuts of nearly 30 percent that were to have taken effect January 1, 2013, CMS has reopened the Par/NonPar decision period. Physicians interested in modifying their Participation or Non-Participation status have until Feb. 15 2013, to do so.

Participating physicians who are opting out of Medicare and privately contracting with their patients must file an affidavit with their Medicare carrier at least 30 days before the start of the quarter in which their opt out takes effect. Whether or not CMS reopens the Par/NonPar decision period, the next date that an opt out affidavit can take effect is April 1, 2013 for physicians who submit affidavits to their carriers by March 1, 2013.

Medicare Revenue 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

Sample letter to patients for practices choosing non-PAR status

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

Medicare Participation Webinar