Gastroenterology Coding Alert

Question: I enjoyed your article last month offering tips for physicians that are new to the Medicare program. We have a new practice and it was very helpful. However, the article said practices that are non-participating with Medicare can still treat Medicare patients and collect 95 percent of the fee schedule (with a limiting charge). We were of the understanding that non-par providers could NOT see Medicare patients. Are you sure this is accurate?

Codify Subscriber

Answer: Yes, it is accurate. Going non-par is different from completely opting out of Medicare altogether. Non-par providers can still see Medicare patients, but they aren’t considered “participating physicians.”

“Participating in the Medicare program simply means that you agree to accept assignment for all services furnished to Medicare patients,” Part B MAC Cahaba GBA says on its website. “By accepting assignment, you agree to accept the amount approved by Medicare as total payment for covered services.”

If you are not participating with Medicare (non-par), you “may receive reimbursement for rendered services directly from their Medicare patients,” explains Part B MAC Noridian Medicare on its website in an article updated in 2018. “They submit a bill to Medicare so the beneficiary may be reimbursed for the portion of the charges for which Medicare is responsible.”

Therefore, if you choose to be non-par with Medicare, you’ll still bill services to the MAC, but you’ll receive less reimbursement (107 percent maximum of 95 percent of the par fee schedule), and in most cases, the MAC will pay the patient directly and the patient will pay you, which could translate into collection headaches.