10% Cut in Medicare Reimbursement - To Stay, or Not to Stay?

The looming 10% cut in physician payments by Medicare has many physicians reconsidering their participation status. If you do not wish to change your status, you don't need to do anything. However, if you feel that a change is necessary, your decision must be made official by December 31st (which is really only 2 weeks away when you consider all the shopping you need to do and the time off for the holidays).

The AMA has outlined a few choices for your practice regarding your Medicare participation:

1. PAR (participating) - you agree to accept the allowed charge as payment in full (80% Medicare, 20% patient copayment).

2. non-PAR (non-participating) - allows you to bill patients for more than the Medicare allowance for unassigned claims.

3. Private Contracting Physician - you bill your patients directly, no Medicare payments are made to you or your patients.


Each decision has it's pros and cons. For example, non-Par physicians will receive5% less than Par physicians (but 95% of relatively nothing is still relatively nothing). The AMA warns: "Those considering a change in status should first determine that they are not bound by any contractual arrangements with hospitals, health plans or other entities that require them to be PAR physicians. In addition, some states have enacted laws that prohibit physicians from balance billing their patients."

Read: AMA's Medicare Particiaption Options for Physicians