Annual Medicare Participation Announcement

Annual Medicare Participation Announcement

Annual Medicare Participation Announcement

View this year's Announcement (PDF). 

Each year from mid-November through December 31, providers can decide if they want to participate in Medicare for the upcoming year. In early to mid-November, your Medicare Administrative Contractor (MAC) will send a post card reminding you about the annual participation open enrollment period. 

We’re pleased that we continue to have a 98% participation rate. As you plan for 2025, view the announcement for information that may help you determine whether you want to continue or become a Medicare-participating provider.

Participating vs. Non-Participating

Medicare “participation” means you agree to accept claims assignment for all Medicare-covered services to your patients. By accepting assignment, you agree to accept Medicare-allowed amounts as payment in full. You may not collect more from the patient than the Medicare deductible and coinsurance or copayment.
 

Participating Provider or SupplierNon-Participating Provider or Supplier
  • Medicare pays the full Medicare Physician Fee Schedule allowed amount 
  • Medicare pays you directly
  • Medicare forwards claim information to Medigap (Medicare supplement coverage) insurance
  • Medicare pays 5% less than the Medicare Physician Fee Schedule allowed amount
  • You can’t charge the patient more than the limiting charge, 115% of the Medicare Physician Fee Schedule amount
  • You may accept assignment on a case-by-case basis
  • You have limited appeal rights

 
Choose the situation that applies to you to find out what to do between mid-November and December 31 each year. 

I'm already participating, and I want to next year.

You don’t need to do anything.

I'm not participating, but I want to next year.

Complete the Medicare Participating Physician or Supplier Agreement (CMS-460) (PDF) and mail it (or a copy) to each MAC to which you’ll send Part B claims. 

I'm a new provider.

Submit the Medicare Participating Physician or Supplier Agreement (CMS-460) (PDF) electronically with your enrollment application.

I'm currently participating, but I don't want to next year.

Write to each MAC to which you send Part B claims telling them that you’re terminating your participation in Medicare effective January 1. This written notice must be postmarked before December 31 of the previous effective year. 

I'm not participating, and I don't want to next year.

You don’t need to do anything.

 

Page Last Modified:
11/04/2024 08:37 AM
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