Changing your Medicare participation status? Here are your options.

Are you thinking of switching your Medicare enrollment status from participating to nonparticipating physician? The deadline to do so is Dec. 31, 2015. Physicians who choose Medicare’s private contracting option must submit notification at least 30 days before the start of the quarter when the contract begins. For more details, read the AOA’s guide to 2016 Medicare participation options.

Medicare enrollment options

For 2016, physicians may choose among three Medicare participation options: Medicare participating physician, Medicare nonparticipating physician, or opt-out/private contracting. The physician fee schedule conversion factor for Medicare will be lower in 2016 than it was in 2015. Here’s a look at what each option entails.

• Medicare participating physicians accept Medicare’s allowed charge as payment in full for all Medicare patients.
• Medicare nonparticipating physicians accept 95% of Medicare-approved amounts for services provided, but may charge up to 115% of the Medicare-approved amount. However, approved amounts for nonparticipating physicians are 95% of the rates for participating physicians. Assignment decisions may be made on a case-by-case basis.
• Opt-out/private contracting physicians must file an opt-out affidavit with their Medicare Administrative Contractor saying they won’t submit claims to Medicare for any treatment to any Medicare patients during the opt-out period. Physicians must submit the affidavit at least 30 days before the first day of the quarter when the contract begins.
• Opt-out affidavits submitted on or after June 16, 2015, will automatically renew every two years. If you don’t want yours renewed, notify your Medicare Administrative Contractor in writing at least 30 days before the next two-year opt-out period begins.