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More Uncertainty Following “Fix” – CMS reopens participation decision period

More Uncertainty Following “Fix” – CMS reopens participation decision period
Jan 8, 2013
The fiscal “fix” may have delayed the dreaded SGR cuts for another year, but doctors still face Medicare pay cuts from the 2% sequester (coming March 1) plus uncertainty about what they can charge. CMS is allowing payments to be held for up to 10 business days (up to January 15) to ensure proper implementation of the new Medicare rates.

Status Change Extension

Due to the last minute “fix,” CMS is extending the 2013 annual participation enrollment period through February 15, 2013.

Physicians now have until February 15 to change their 2013 Medicare participation status.

This means that physicians who currently have a participating status (PAR) in Medicare have until February 15 to change their status to non-participating (non-PAR) or vice versa.

This is done by writing to the Medicare contractor(s) the physician deals with, and requesting the change in status. A list of Medicare carriers by state can be found at http://www.cms.gov/MedicareProviderSupEnroll/downloads/contact_list.pdf.

An AAPS video summarizing Medicare participation options is available at: http://youtu.be/_pb9vleSDXY .

What about Opting-Out?

Opted-out is a third Medicare status, distinct from PAR and non-PAR, which allows private contracting with Medicare patients.

Despite the Feb. 15 CMS extension, if your current status with Medicare is PAR then “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,” according to the AMA.

However, if you already have non-PAR status in Medicare, you may opt-out at any time by providing an opt-out affidavit to your Medicare contractor(s) no later than 10 days after the first private contract is entered into. 

Medicare’s rules regarding opting-out can be reviewed at https://www.cms.gov/manuals/downloads/bp102c15.pdf starting at the bottom of page 22 – Section 40.

If you search on Google for “opting out of Medicare,” the AAPS site comes up first, and offers many useful tools. But other organizations, including AMA, are now offering information also. 

AAPS also has many videos of members explaining how and why they decided to opt-out of Medicare and/or establish a third-party-free practice.

It is highly recommended that physicians request and obtain written confirmation from their Medicare contractor that any change in Medicare status has been properly completed before billing as a non-PAR physician or entering into a private contract, if opting-out.

A Fourth Option?

CMS and AMA are silent on the fourth, disenrollment option. Secretary Sebelius has refused to answer our questions about this.

As far as we have been able to determine, no disenrolled physician has been fined $2,000 for refusing to take taxpayers’ money, but many threat letters have been sent regarding the mandatory claims submission.

Reasons for disenrolling instead of opting out are (1) patients may be able to collect some of the benefits to which they are entitled by filing Form 1490s, (2) not having to re-opt out every two years and cope with carriers who “lose” or try to deny the application, (3) the ability to disenroll at any time, and (4) fewer hassles, as of patients having to sign CMS-approved contracts, over and over again.

Reasons for opting out are that (1) it is a “safe harbor” specifically provided for by law rather than a gray area; (2) it will be easier for patients to obtain reimbursement for procedures and tests ordered by the opted-out physician.

In the rush to freedom, don’t be left behind!

Watch Video on Your Medicare Payment Options

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More Uncertainty Following “Fix” – CMS reopens participation decision period

The fiscal "fix" may have delayed the dreaded SGR cuts for another year, but doctors still face Medicare pay cuts from the 2% sequester (coming March 1) plus uncertainty about what they can charge. CMS is allowing payments to be held for up to 10 business days (up to January 15) to ensure proper implementation of the new Medicare rates.

Status Change Extension

Due to the last minute "fix," CMS is extending the 2013 annual participation enrollment period through February 15, 2013.

Physicians now have until February 15 to change their 2013 Medicare participation status.

This means that physicians who currently have a participating status (PAR) in Medicare have until February 15 to change their status to non-participating (non-PAR) or vice versa.

This is done by writing to the Medicare contractor(s) the physician deals with, and requesting the change in status. A list of Medicare carriers by state can be found at http://www.cms.gov/MedicareProviderSupEnroll/downloads/contact_list.pdf.

An AAPS video summarizing Medicare participation options is available at: http://youtu.be/_pb9vleSDXY .

What about Opting-Out?

Opted-out is a third Medicare status, distinct from PAR and non-PAR, which allows private contracting with Medicare patients.

Despite the Feb. 15 CMS extension, if your current status with Medicare is PAR then "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," according to the AMA.

However, if you already have non-PAR status in Medicare, you may opt-out at any time by providing an opt-out affidavit to your Medicare contractor(s) no later than 10 days after the first private contract is entered into. 

Medicare's rules regarding opting-out can be reviewed at https://www.cms.gov/manuals/downloads/bp102c15.pdf starting at the bottom of page 22 – Section 40.

If you search on Google for “opting out of Medicare," the AAPS site comes up first, and offers many useful tools. But other organizations, including AMA, are now offering information also. 
 
AAPS also has many videos of members explaining how and why they decided to opt-out of Medicare and/or establish a third-party-free practice.

It is highly recommended that physicians request and obtain written confirmation from their Medicare contractor that any change in Medicare status has been properly completed before billing as a non-PAR physician or entering into a private contract, if opting-out.
 
A Fourth Option?

CMS and AMA are silent on the fourth, disenrollment option. Secretary Sebelius has refused to answer our questions about this.

As far as we have been able to determine, no disenrolled physician has been fined $2,000 for refusing to take taxpayers’ money, but many threat letters have been sent regarding the mandatory claims submission.

Reasons for disenrolling instead of opting out are (1) patients may be able to collect some of the benefits to which they are entitled by filing Form 1490s, (2) not having to re-opt out every two years and cope with carriers who “lose” or try to deny the application, (3) the ability to disenroll at any time, and (4) fewer hassles, as of patients having to sign CMS-approved contracts, over and over again.

Reasons for opting out are that (1) it is a “safe harbor” specifically provided for by law rather than a gray area; (2) it will be easier for patients to obtain reimbursement for procedures and tests ordered by the opted-out physician.

In the rush to freedom, don’t be left behind!

Watch Video on Your Medicare Payment Options

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AAPS asks CA Supreme Court to Protect Physican Free Speech