As a Medicare enrolled supplier/provider, you have the option to choose to be a participating or non-participating provider.
When you’re a Medicare-participating provider:
- You are paid the full Medicare Physician Fee Schedule allowed amount. If you’re a nonparticipating provider, Medicare pays 5% less than the Medicare Physician Fee Schedule allowed amount.
- Medicare pays you directly (on an assignment-related basis).
- Medicare forwards claim information to Medigap (Medicare supplement coverage) insurance (if any).
What to Do:
By December 31, 2024, all physicians, practitioners, and suppliers – regardless of their Medicare participation status – must decide whether to participate for CY 2025.
- If you’re already participating in Medicare, and you want to continue your participation, you don’t need to do anything.
- If you’re not currently participating, and you want to participate in Medicare next year, complete the Medicare Participating Physician or Supplier Agreement (CMS-460). By signing this agreement, you agree to accept assignment for all covered services that you provide to Medicare patients in CY 2025. Mail a copy to your respective National Provider Enrollment Contractor (NPE), Novitas Solutions or Palmetto GBA. If you’re a newly enrolling Medicare provider, you can submit the agreement electronically with your enrollment application.
- If you don’t want to participate in Medicare next year, and you’re currently participating, write to each MAC that you send Part B DMEPOS claims to telling them that you don’t want to participate effective January 1, 2025. This written notice must be postmarked before December 31, 2024.
- If you’re not currently participating, and you don’t want to participate, you don’t need to do anything.
DMEPOS Suppliers should expect to receive a postcard from the National Provider Enrollment Contractors (NPEs) in the upcoming weeks, reminding them of the opportunity to update your current participation. It is also important to note, these mailings will be sent to the Correspondence Address that you have listed on your Supplier Enrollment file. If your address is incorrect and, therefore, cannot be delivered, it will be marked as NONDELIVERABLE and sent back to your respective NPE.
All returned/nondeliverable postcards will result in the NPE auditing your provider enrollment record, which could result in a revocation for not reporting changes in information timely.
Do not put your PTAN at risk! Log into PECOS and review the correspondence address listed to ensure it is correct.
Did you Know?
Did you know The van Halem Group provider enrollment support services? Whether you are enrolling in Medicare as a new DMEPOS supplier or need assistance with making updates/changes to your enrollment, we can help! Our team can work with your compliance/licensing department to ensure changes are reported timely and correctly.
Avoid potential revocations or deactivations, with our help! Contact Us today to see how we can help ensure your enrollment record is up to date and accurate!