2018 Participation announcement
Click here to view the Centers for Medicare & Medicaid Services (CMS) announcement about Medicare participation for calendar year (CY) 2018.
If you bill for physicians’ professional services, services and supplies provided incident to physicians’ professional services, outpatient physical and occupational therapy services, diagnostic tests, or radiology services, your Medicare fee schedule amounts are five percent higher if you participate. Also, providers receive direct and timely reimbursement from Medicare. Regardless of the Medicare Part B services for which you are billing, participants have “one stop” billing for beneficiaries who have nonemployment-related Medigap coverage and who assign both their Medicare and Medigap payments to participants. After Medicare payment has been made, Medicare contractors automatically send the claim on to the Medigap insurer for payment of all coinsurance and deductible amounts due under the Medigap policy. The Medigap insurer must pay the participant directly.
When is the enrollment period?
Every year, contractors conduct an open participation enrollment period in order to provide eligible physicians, practitioners and suppliers with an opportunity to make their calendar year Medicare participation decision. Participation agreements cover the period January 1, 2018, through December 31, 2018, and may not be changed after December 31, 2017.
What do I have to do?
If you choose to be a participant in calendar year (CY) 2018:
• Do nothing if you are currently participating, or
• If you are not currently a Medicare participant, complete the blank participation agreement (form CMS-460 ) and mail it (or a copy) to each Medicare administrative contractor (MAC)/carrier to which you submit Part B claims. On the form show the name(s) and identification number(s) under which you bill.
• The signed form CMS-460 must be postmarked no later than December 31, 2017.
If you decide not to participate in CY 2018:
• Do nothing if you are currently not participating, or
• If you are currently a participant, write to each MAC/carrier to which you submit claims advising of your termination effective January 1, 2018.
• This written notice should be on the provider’s letterhead, must be dated, and must include:
• The provider’s name, PTAN(s), and SSN, and
• A statement indicating that you are rescinding your participation agreement.
• The written notice must be postmarked no later than December 31, 2017.
Note: Any participating health care professional who is not changing their participation status does not need to take any action during this annual participation open enrollment period.
Where do I submit my request?
For First Coast Service Options Inc. (First Coast), the MAC for jurisdiction N (JN), which includes Florida, Puerto Rico, and the U.S. Virgin Islands, submit your completed CMS-460 form or disenrollent request to:
P.O. Box 44021
Jacksonville, FL 32231-4021
P.O. Box 44021
Jacksonville, FL 32231-4021
Click here to find web addresses for other MACs/carriers. You can locate their mailing addresses for participation enrollment from their websites.
How can I find reimbursement rates for 2018?
We understand that providers want to know what Medicare payment will be like in 2018 before making their participation decisions. When available, Medicare physician fee schedule (MPFS) fees for services rendered during 2018 will be at: https://medicare.fcso.com/Fee_news/.
Where can I find more information?
We encourage you to visit the Medicare Learning Network® (MLN) (https://www.cms.gov/Outreach-and-Education/Medicare-Learning-Network-MLN/MLNGenInfo/index.html ) the place for official CMS Medicare Fee-For-Service provider educational information. There you can find one of our most popular products, MLN Matters national provider education articles. These articles help you understand new or changed Medicare policy and how those changes affect you. A full array of other educational products (including web-based training courses, hard copy and downloadable publications, and CD-ROMs) are also available and can be accessed at: https://www.cms.gov/Outreach-and-Education/Medicare-Learning-Network-MLN/MLNProducts/index.html . You can also find other important websites by visiting the Physician Center web page at: https://www.cms.gov/Center/Provider-Type/Physician-Center.html, and the All Fee-For-Service Providers web page at https://www.cms.gov/Center/Provider-Type/All-Fee-For-Service-Providers-Center.html .
In addition to educational products, the MLN also offers providers and suppliers opportunities to learn more about the Medicare program through MLN national provider calls. These national conference calls, held by CMS for the Medicare Fee-For-Service provider and supplier community, educate and inform participants about new policies and/or changes to the Medicare program. Offered free of charge, continuing education credits may be awarded for participation in certain national provider calls. To learn more about MLN National provider calls including upcoming calls, registration information, and links to previous call materials, visit https://www.cms.gov/Outreach-and-Education/Outreach/NPC/index.html .
First Coast Service Options (First Coast) strives to ensure that the information available on our provider website is accurate, detailed, and current. Therefore, this is a dynamic site and its content changes daily. It is best to access the site to ensure you have the most current information rather than printing articles or forms that may become obsolete without notice.