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Participate or Not To Participate

Medicare
in Medicare

That is the Question

There is only one time per year when a provider can make changes to their Medicare participation status. The annual open enrollment period runs from mid-November through December 31. During the open enrollment period, which is approximately 45 days in length, if a par-provider wants to become non-par, he/she must submit notification in writing; otherwise, the par-provider status will renew automatically each year.

What to Do During Open Enrollment? According to CMS, if you choose to be a participant:

  • Do nothing if you are currently participating, or
  • If you are not currently a Medicare participant, complete the blank agreement CMS 460 and mail it (or a copy) to each carrier to which you submit Part B claims. (On the form show the name(s) and identification number(s) under which you bill.)

If you decide not to participate:

  • Do nothing if you are currently not participating, or
  • If you are currently a participant, write to each carrier to which you submit claims, advising of your termination effective the first day of the next calendar year. This written notice must be postmarked prior to the end of the current calendar year.

Additional Information is available online here.

Library Members can find a helpful fact sheet titled “Medicare Participation and Non-Participation” that summarizes the advantages and disadvantages in Medicare Classroom 1 Lesson 3 titled “ "Being A Medicare Provider".

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