Medicare Participation for Calendar Year 2012

The Centers for Medicare & Medicaid Services extended the 2012 open enrollment period for Medicare participation to February 14, 2012. All new participation agreements and notices of withdrawal from participation must have been postmarked on or before February 14, 2012, in order to be accepted.

The open enrollment period for Medicare participation during calendar year (CY) 2012 extends from mid-November through December 31, 2011. Physicians, practitioners, and suppliers must make their Medicare participation decision for CY 2012 by December 31, 2011. Providers who want to maintain their current participation status, participating or non-participating, do not need to take any action during this annual participation enrollment program.

To sign a participation agreement is to agree to accept assignment for all covered services provided to Medicare beneficiaries during CY 2012. Providers who accept assignment must accept Medicare's approved charge as the provider's full charge for covered services. They may bill the beneficiary only for amounts applied to deductible, for the 20 percent coinsurance, and for non-covered charges. During 2011, more than 95 percent of all physicians and practitioners are billing under Medicare participation agreements.

Why Participate?

Medicare payment on assigned claims is issued directly to the provider. Non-participating providers not subject to mandatory assignment may accept assignment on a claim-by-claim basis, but for services paid under the Medicare physician fee schedule, Medicare's approved charge is five percent less than the approved charge for a participating provider. Nonparticipating providers are subject to Medicare's limiting charge and can bill Medicare beneficiaries no more than 115 percent of the approved change on non-assigned claims.

Participation facilitates payment from the beneficiary's Medigap plan for costs not paid by Medicare. Participants have "one stop" billing for beneficiaries who have Medigap coverage not connected with their employment and who assign both their Medicare and Medigap payments to participants. After Medicare has made payment, the claim is sent on to the Medigap insurer for payment of all coinsurance and deductible amounts due under the Medigap policy. The Medigap insurer must pay the participant directly.

What to Do

Providers who choose to be a participant in CY 2012 should do nothing if they are currently participating. If they are not currently participating, they should complete the blank Medicare Participating Physician or Supplier Agreement, Form CMS-460Adobe Portable Document Format, and send it to Wisconsin Physicians Service (with a copy to any other Medicare contractors to which they submit claims).

Providers who decide not to participate in CY 2012 should do nothing if they are currently not participating. If they are currently participating, they should write to each Medicare contractor to which they submit claims, advising of the termination of their participation agreement effective January 1, 2012. This written notice must be postmarked prior to January 1, 2012.

For group practices and organizations, participation agreements and notices of withdrawals must be signed by an individual who has been reported to and approved by Medicare as an authorized or delegated official. For sole proprietorships, the participation agreement or notice of withdrawal must be signed by the physician or non-physician practitioner.

Note: Providers who are not yet enrolled in the Provider Enrollment, Chain & Ownership System (PECOS) will be asked to complete the appropriate CMS-855 enrollment forms when making a change to their participation status.

Providers should send their new participation agreements and letters to terminate participation to Wisconsin Physicians Service at the following address. They may call the telephone number indicated with questions regarding Medicare's participation program.

Priority Mailing Address
Wisconsin Physicians Service
Medicare Provider Enrollment
1707 W. Broadway
Madison, WI 53713-1838
 
Wisconsin Physicians Service
Medicare Provider Enrollment
P.O. Box 8248
Madison, WI 53708-8248
(866) 503-7664


CMS Participation AnnouncementAdobe Portable Document Format

Page Last Updated: Monday, 05-Mar-2012 15:35:31 CST