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Date: Friday, May 17, 1996 FOR IMMEDIATE RELEASE Contact: HCFA Press Office (202)690-6145
More than three-quarters of the physicians and other practitioners who serve Medicare beneficiaries have enrolled in the Medicare participating physician program for 1996, HHS Secretary Donna E. Shalala announced today. Participation ranges from a high of 92.2 percent in North Dakota to a low of 60.1 percent in Idaho.
The overall rate of participation is 77.5 percent this year, up from 72.3 percent in 1995. The number of enrollees in the program has increased to 627,000 in 1996 from 620,000 last year. Participation rose in 45 states, as well as the District of Columbia, Puerto Rico and the Virgin Islands.
"Under the participating physician program, beneficiaries do not pay charges above Medicare-approved limits," Shalala said. "Medicare beneficiaries have found this to be a valuable program for more than 10 years."
Participation has risen every year since the program started in 1984. The overall rate includes medical doctors (MDs), limited license practitioners and nonphysician practitioners:
"Two principal factors contribute to the increases in the physician participation program," said Bruce C. Vladeck, administrator of the Health Care Financing Administration, which manages Medicare. "We continue to remind beneficiaries about the program's benefits and we enforce the limits placed on charges made by nonparticipating physicians."
A participating physician agrees to accept Medicare fee schedule amounts as full payment for Medicare service.
"Services provided by participating physicians now account for just over 90 percent of Medicare-allowed charges for physician services," Vladeck said.
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 a beneficiary more, up to a limit defined by law.
Some nonphysician practitioners are required by law to "accept assignment" for all covered services. (That is, they accept the Medicare fee schedule amount as full payment.) They are certified registered nurse anesthetists, physician assistants, nurse practitioners, nurse midwives, clinical nurse specialists, clinical psychologists and clinical social workers. Nonphysician practitioners who do not have to accept assignment are audiologists, physical therapists, psychologists and occupational therapists.
Physicians are advised that participating in the program creates the following advantages:
Nonparticipating providers are advised they can charge beneficiaries no more than 115 percent of the Medicare allowance.
Attached is a table showing the state-by-state rates of participating physicians and other practitioners.
PARTICIPATION RATES BY STATE (Enrollment by percent for MDs and other practitioners) STATES JANUARY 1995 JANUARY 1996 ALABAMA 90.5 91.8 ALASKA 77.1 73.5 ARIZONA 87.1 85.2 ARKANSAS 74.8 77.2 CALIFORNIA 74.5 80.5 COLORADO 65.2 79.5 CONNECTICUT 61.8 84.3 DELAWARE 68.0 72.2 DISTRICT OF COLUMBIA 63.0 65.3 FLORIDA 68.0 70.9 GEORGIA 86.3 87.2 HAWAII 82.8 83.6 IDAHO 54.7 60.1 ILLINOIS 73.3 75.6 INDIANA 72.8 75.7 IOWA 81.1 83.6 KANSAS 84.4 91.1 KENTUCKY 83.4 85.8 LOUISIANA 57.4 61.0 MAINE 68.9 77.2 MARYLAND 88.1 89.9 MASSACHUSETTS 64.7 74.9 MICHIGAN 75.3 80.2 MINNESOTA 58.6 70.6 MISSISSIPPI 59.4 77.3 MISSOURI 87.6 86.8 MONTANA 70.1 77.4 NEBRASKA 82.5 86.3 NEVADA 91.2 90.8 NEW HAMPSHIRE 60.4 77.0 NEW JERSEY 54.9 60.6 NEW MEXICO 78.1 80.7 NEW YORK 59.2 64.2 NORTH CAROLINA 77.6 81.0 NORTH DAKOTA 81.8 92.2 OHIO 90.5 91.8 OKLAHOMA 72.3 76.1 OREGON 79.7 82.1 PENNSYLVANIA 67.3 69.3 PUERTO RICO 70.7 84.3 RHODE ISLAND 80.9 66.8 SOUTH CAROLINA 76.1 82.7 SOUTH DAKOTA 51.7 71.4 TENNESSEE 80.6 83.1 TEXAS 76.9 80.3 UTAH 85.9 86.8 VERMONT 68.8 76.1 VIRGINIA 55.6 84.3 VIRGIN ISLANDS 32.7 40.0 WASHINGTON 76.2 86.4 WEST VIRGINIA 87.2 89.3 WISCONSIN 81.2 83.9 WYOMING 66.1 81.2