Medicare News
| For Immediate Release: | Contact: |
| Tuesday, May 06, 1997 | CMS Office of Public Affairs 202-690-6145 |
For questions about Medicare please call 1-800-MEDICARE or visit www.medicare.gov. |
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PRACTITIONER ENROLLMENT IN MEDICARE PROGRAM INCREASES FOR 1997
About 80 percent of physicians and other health care practitioners have enrolled in the Medicare participating physician program for 1997, HHS Secretary Donna E. Shalala announced today. A participating provider accepts Medicare fee schedule amounts as payment in full.
The overall participation rate is now 80.2 percent, up from 77.5 percent last year. The actual number of participants increased to 691,000, from 672,000 in 1996.
"The rising participation rate is good news for Medicare beneficiaries because it means they can see more providers without worrying about being charged more than the standard copayment amount," said Secretary Shalala.
Participation has risen every year since the program started. This year, the rate increased:
- to 82.4 percent for MDs and doctors of osteopathy, up from 80 percent in 1996;
- to 54.1 percent for limited license practitioners (optometrists, podiatrists, chiropractors or oral surgeons), up from 50.3 percent in 1996; and
- to 95.2 percent for nonphysician practitioners (such as physician assistants and nurse practitioners), up from 93.1 percent in 1996.
"Our continuing efforts to promote Medicare's benefits to beneficiaries and physicians, as well as to enforce the limit on charges made by nonparticipating physicians, have contributed to the increase in participation," said Bruce C. Vladeck, administrator of HHS' Health Care Financing Administration, which runs the Medicare program.
Services provided by participating physicians now account for more than 92 percent of Medicare-allowed charges for physician services.
Medicare pays 80 percent of the fee schedule amount for a physician's service. For a Medicare-covered service provided by a participating physician, the beneficiary is responsible for 20 percent of the fee schedule amount. A nonparticipating physician, however, may charge up to 115 percent of the Medicare fee schedule amount, with the beneficiary thus being responsible for a greater portion of the total fee.
Participation includes several advantages for the provider. The Medicare fee schedule is 5 percent higher than for nonparticipants. Participants can use toll-free lines to submit claims electronically. And they are included in a Medicare Participating Physician/Supplier Directory.
