Participating vs Non-participating

Initially, the provider is enrolled in the Medicare program as non-participating. Providers are given 90 days from the date of enrollment to choose if they want to become participating. If a provider does not choose to participate during this initial enrollment period, he/she will be given the opportunity each year (usually in November and December) to change his/her participation status.

Participating doctors and suppliers agree to accept assignment on all Medicare claims. Certain practitioners (e.g., social workers) are automatically enrolled as participating, since they must accept assignment

if they bill Medicare.

The advantages of being a participating provider:

• Higher Allowances (5%)
• Direct Payment
• Medigap Transfer
• Publicity in the Medicare Participating Physician/Supplier Directory (MEDPARD)

Non-Participating doctors and suppliers sign no agreements, and may choose on a claim by claim basis whether or not they want to accept assignment. Non-participating providers who do not accept assignment on a claim will be limited as to the amount they charge the beneficiary.

Know more about participating provider