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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 for 2015 ends Dec. 31, 2014. 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 21 percent cut to Medicare payments is scheduled to take effect April 1, 2015 under current law. The AMA’s Fix Medicare Now campaign is working to secure repeal of the formula that leads to this annual threat of steep pay cuts.

There are three Medicare contractual options for physicians:

  • 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 2015

Find contact information for your Medicare contractor here

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