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HME Reimbursement Advice: Being a Participating Provider in 2017 May Limit Your Options

Posted on in Billing/Reimbursement

With the end of the year approaching fast, now is the time to decide if you will be a participating (par) or non-participating provider.

Before making your decision, we highly encourage you to watch this video, read the article below and download these slides from reimbursement experts Ronda Buhrmester and Dan Fedor. Unlike golf, being par may not be favorable for you.

Do you know you don't have to be a participating (par) provider to accept Medicare patients? Non-participating (non-par) providers can still provide products and services to Medicare patients. Do you know if your company is listed as par or non-par? This is a very important thing to know because of the recent Medicare allowable reductions (Jan. 2016 and July 2016) and because the only time to change this status is between Nov. 15 and Dec. 31 (for the following calendar year). 

If you are listed as a par provider, you are limited to accepting assignment (the Medicare allowable) for all Medicare patients, and this can possibly put you in a position of either losing money on a transaction or turning the patient away. If you are a non-par provider, you can still accept Medicare patients, and when the allowable is adequate, you can accept assignment on the claim; however, when the allowable is not adequate, you can choose a non-assigned claim, where you can charge your usual and customary charge/MSRP (above the Medicare allowable). But, in order to have the option of a non-assigned claim, you must be listed with the NSC as non-participating.

Are there any benefits to being a par provider?

The only pro to being a par provider is your company is listed in a Medicare directory as a par provider (accepts assignment on all Medicare claims). The con to being a par provider is if you accept a Medicare patient as a customer, you must accept assignment on the claim (accept the Medicare allowable as payment in full).

Now is the time to determine your status and, if necessary, make a change as you only have until Dec. 31 to notify the NSC. 

  • Verify if you are par or non-par provider (http://www.palmettogba.com/nsc).
  • Determine if a change is necessary.
  • If you are par provider and wish to change to non-participating, you must submit a letter signed by the authorized official to the NSC during the open enrollment period (Nov. 15-Dec. 31). The change will be effective Jan. 1 of the following year.

If you are a VGM member and would like additional information on this topic, please contact us at the information below. 

Ronda Buhrmester
888-665-6518
ronda.buhrmester@vgm.com

Dan Fedor
844-794-8459
dan.fedor@vgm.com

 

 

 

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