Medicare Open Enrollment Period for Medical Providers

Medicare Open Enrollment for PROVIDERS is here!

Do you see Medicare patients? You’re going to want to keep reading!

The Medicare Open Enrollment Period (OEP) for medical providers runs from mid-November to December 31. Medical providers can enroll in Medicare or make changes to their existing enrollment!

How can medical providers enroll in Medicare?

Medical providers can enroll in Medicare online at the Medicare Provider Enrollment, Chain, and Ownership System (PECOS) website. To enroll in Medicare, providers will need to create a PECOS account and submit their enrollment information through there. Your PECOS account information will also be the same as your NPPES login information, the place where you created and update your NPI information at.

How can medical providers make changes to their existing Medicare enrollment?

Medical providers can make changes to their existing Medicare enrollment online at the PECOS website. To make changes to their enrollment, providers will need to log into their PECOS account and update their information. What’s important to note here is why a provider may want to change their participation status this time of year. See the difference between PAR and NON PAR enrollment below:

If you are participating with Medicare, you:

Must submit the claims to Medicare
Are being paid directly by Medicare
Claims are automatically forwarded to secondary carriers who will also reimburse you (the provider), and
Cannot charge the patient above and beyond the Medicare allowed rate

If you are non participating with Medicare, you:

Must submit the claims to Medicare
Can choose on a case-by-case basis if you want to be paid directly by Medicare or if Medicare reimburses your patient directly (you would then collect your fees up front form the patient), and
CAN charge 115% of the Medicare Physician Fee Schedule amount, allowing you to charge more than Medicare’s allowed amount.

Here are a few tips for medical providers during the Medicare OEP:

Start early. Don't wait until the last minute to enroll in Medicare or make changes to your existing enrollment. This will give you time to resolve any issues that may arise.
Review your information carefully. Make sure that all of your information is accurate and up-to-date. This includes your address in both PECOS and NPPES (NPI Portal). This will help to ensure that your enrollment is processed smoothly.
Keep copies of all documentation. Keep copies of all of the documentation that you submit to Medicare. This will help you to resolve any issues that may arise with your enrollment.

Additional resources for medical providers:

The following resources can provide additional information to medical providers about the Medicare OEP and provider enrollment:
- Medicare Provider Enrollment, Chain, and Ownership System (PECOS) website
- Medicare Open Enrollment Period for Medical Providers article on the Centers for Medicare & Medicaid Services (CMS) website
- Medicare Enrollment for Providers guide from the American Medical Association (AMA)
By following these tips, medical providers can ensure that they are enrolled in Medicare and that their information is up-to-date during the Medicare OEP.

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