Benefits
of Participation in Medicare
- A fee schedule that is five percent higher on all services which could be or are paid under the physician fee schedule. This five percent differential applies regardless of what entity bills for the service.
- Automatic crossover of claims to Medigap insurers.
- No limit on the amount of charges submitted to Medicare. This allows the participating physician to use the same fee schedule for Medicare and non-Medicare patients.
- Having the provider name, address, and telephone number listed in the online Medicare Participating Physician Directory. The online directory can be found at http://www.medicare.gov/physician/home.asp. The online directory allows users to search for Medicare Participating Physicians. Providers may also log on to www.cignagovernmentservices.com and www.cms.gov for other Medicare information.
Although providers may enroll in the Medicare program or change an enrollment status at anytime, there are only two instances in which providers may enroll in or terminate enrollment from the participation program. One is within 90 days of initial enrollment into the Medicare program. The other is during the annual open enrollment period.
Participating physicians and suppliers voluntarily enter into an agreement to accept assignment for all services rendered to Medicare beneficiaries. This agreement (contract) is for a 12-month period beginning January 1, of each year. The agreement is effective the date it is received by the carrier.
Please note: If a provider is under going a tax ID change or changing status, i.e., leaving or forming new groups, the Participation Agreement does not automatically roll over. Please be sure to check with Provider Enrollment if you are in doubt of your need to submit a new participation agreement.
