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Every year from mid-November through December 31, providers can decide if they want to participate in Medicare for the upcoming year. In early to mid-November, your MAC will send a post card reminding you about the annual participation open enrollment period. 

Participating vs. Non-Participating
Medicare “participation” means you agree to accept claims assignment for all Medicare-covered services to your patients. By accepting assignment, you agree to accept Medicare-allowed amounts as payment in full. You may not collect more from the patient than the Medicare deductible and coinsurance or copayment. 

If you choose to be a “non-participating supplier,” you may accept assignment on a claim-by-claim basis.” If a non-participating supplier does not accept assignment, the supplier can charge more than the Medicare allowable and will collect directly from the patient. In this instance, the supplier is required to file the claim with Medicare on a non-assigned basis on behalf of the patient, and any Medicare reimbursement is sent directly to the patient.

Participating Supplier       Non-Participating Supplier
  • Medicare pays you directly
  • Medicare forwards claim information to Medigap (Medicare supplement coverage) insurers
  • You may accept assignment on a case-by-case basis
  • You have limited appeal rights

If you are currently enrolled as a participating or non-participating supplier and want to continue in that capacity, than you do not need to anything, your participation status will not change. 

If you would like to change your participation status to non-participating, you will need to submit a written notice to each of the DME MACs to which you send DMEPOS claims, telling them that you’re terminating your participation in Medicare effective January 1. This written notice must be postmarked before December 31 of the previous effective year. 

If you would like to change your non-participation status to participating, complete the Medicare Participating Physician or Supplier Agreement (CMS-460) and mail it to each of the DME MACs to which you’ll send DMEPOS claims. 

Did you know....

The van Halem Group offers a wide variety of enrollment support services, including help with intial enrollment, revalidation, changes to your current enrollment file, and assistance with Corrective Action Plans (CAP) and reconsiderations in the event of a denied enrollment or PTAN revocation. 

Contact us today to learn how we can help you maintain your enrollment with Medicare and Medicaid.