Medicare Compliance & Reimbursement

If you’re not a Medicare participating (PAR) provider but are toying with the idea of enrolling, the window is open. But don’t delay, as your 2023 decision is due soon.

Details: Between Nov. 15 and Dec. 31 of each year, the Centers for Medicare & Medicaid Services (CMS) has an open enrollment period for interested providers for participation in the upcoming year.

“A participating provider enters into an agreement (CMS-460) (PDF) to accept the Medicare-approved amount as full payment for services and supplies covered under Part B,” notes Part B Medicare Administrative Contractor (MAC) Palmetto GBA in online guidance. And one of the perks of being a Medicare PAR provider: You receive 5 percent more reimbursement than Non-PARs.

Know this: “The participation agreement will automatically renew each year. However, if there is a name or EIN (tax identification number) change, you will need to complete a new participation agreement,” Palmetto instructs.

The Part B MAC adds, “If you have not signed a participation agreement, you or your organization are listed as a non-participating provider and subject to the limiting charge fee schedule.”

Review CMS guidance on the 2023 participation year at www. cms.gov/files/document/medicare-participation-announcement. pdf.