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Provider Enrollment: Announcement About Medicare Participation for Calendar Year 2022

This announcement provides information that may be helpful to clinicians in determining whether to become a Medicare participating provider, or to continue Medicare participation. CMS pledges to put patients first. To do this, we must empower patients to work with their clinicians and make health care decisions that are best for them. This means giving them meaningful information about quality and costs to be active health care consumers. It also includes supporting innovative approaches to improving quality, accessibility and affordability, while finding the best ways to use innovative technology to support patient-centered care. But we can’t do all of this without your involvement. Please visit the CMS website to learn more about our efforts to strengthen the Medicare Program.

Becoming a Participating Medicare Provider

All physicians, nonphysician practitioners and other suppliers – regardless of their Medicare participation status – must make their CY 2022 Medicare participation decision by 12/31/2021. Participating providers (those with PAR status) have signed an agreement to accept assignment for all Medicare-covered services provided to Medicare patients. Assignment means that the provider agrees (or is required by law) to accept the Medicare-approved amount as full payment for Medicare-covered services. Nonparticipating providers (those with Non-PAR status) have not signed an agreement to accept assignment for all Medicare-covered services, but they can still choose to accept assignment for individual services.

Providers who want to maintain their current PAR status or Non-PAR status do not need to take any action during the upcoming annual participation enrollment period. To sign a participation agreement is to agree to accept assignment for all covered services that you provide to Medicare patients.

If you participate in Medicare and bill for services paid under the Medicare physician fee schedule, your Medicare physician fee schedule amounts are five percent higher than if you do not participate in Medicare. Your MAC publishes an electronic directory of participating physicians, nonphysician practitioners and other suppliers.

What To Do

If you choose to participate in Medicare in CY 2022:

  • Do nothing if you are currently participating, or
  • If you are not currently participating, complete the Medicare Participating Physician or Supplier Agreement and mail it (or a copy) to each MAC to which you will 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 in Medicare in CY 2022:

  • Do nothing if you are currently not participating, or
  • If you are currently participating in Medicare, write to each MAC to which you submit Part B claims, advising them of the termination of your participation in the Medicare program effective 1/1/2022. This written notice must be postmarked prior to 12/31/2021.

Please call (J6: 877-908-8476/JK: 888-379-3807) if you have any questions or need further information on participation.

The MLN® offers many products on how providers and suppliers can enroll in the Medicare Program. View the MLN® Educational Tool Medicare Provider Enrollment for details. These products include specific information for physicians and other Part B suppliers; ordering/referring providers; institutional providers; and Durable Medical Equipment, Prosthetics, Orthotics and Supplies suppliers, as well as information on the electronic Medicare enrollment system, PECOS.

Opting Out of Medicare

The Medicare Program offers a number of benefits to physicians, nonphysician practitioners and other suppliers, including timely payment by Medicare for services rendered. However, the Medicare program does carry a number of requirements. For example, providers often must comply with quality reporting requirements.

Certain physicians and nonphysician practitioners who do not wish to engage with the Medicare Program may opt out of Medicare. Opting out of Medicare allows the provider to directly negotiate with Medicare beneficiaries regarding payment for their health care services. While Medicare would not pay for services provided by an “opt-out” physician or practitioner except for urgent or emergency medical care, beneficiaries and providers would have the flexibility to set mutually acceptable payment terms through a negotiated private contract. Providers that opt out can offer and enter into arrangements with beneficiaries that would otherwise be prohibited under Medicare. Opt-out physicians also need not follow certain Medicare requirements, such as deciding on a case by case basis whether, in compliance with Medicare’s rules and guidance, to provide an advance beneficiary notice of non-coverage for services. Medicare will still pay opt-out providers for emergency or urgent care services rendered to beneficiaries without a private contract. More information can be found by visiting Opt-Out Affidavits.

The MLN®, MLN Connects® and MLN Matters® are registered trademarks of the DHHS.

National Government Services

Jurisdiction 6 Jurisdiction K
Mailing Address:
National Government Services, Inc.
P.O. Box 6475 | Indianapolis, IN 46206-6475
Website: NGSMedicare.com

Contact Enrollment: 877-908-8476
Hours Available: Monday–Friday, 8:00 a.m.–4:00 p.m. CT

Closed for training on the 2nd and 4th Friday of the month: 11:00 a.m.‑3:00 p.m. CT
Mailing Address:
National Government Services, Inc.
P.O. Box 7149 | Indianapolis, IN 46207-7149
Website: NGSMedicare.com

Contact Enrollment: 888-379-3807
Hours Available: Monday–Friday, 8:00 a.m.–4:00 p.m. ET

Closed for training on the 2nd and 4th Friday of the month: 12:00–4:00 p.m. ET

Posted 12/7/2021