Department of Health and Human Services - Health Care Financing Administration
SUBJECT: 1998 Participation Enrollment Material
The purpose of this memorandum is to furnish you with material needed for the 1998 participation enrollment process. The following documents are attached:
Reproduce these attachments for your 1998 participation enrollment/fee disclosure packages. See Medicare Carriers Manual (MCM) 17001.1 for fee disclosure guidelines applicable for procedure codes that are valid during 1998.
You may begin mailing participation enrollment/fee disclosure packages as soon as they are printed and assembled and must have t em mailed no later than December 15, 1997. The 1998 participation enrollment period will run through February 2, 1998.
Participation Agreements Received Prior to January 1, 1998
Physicians and practitioners who submit their participation enrollment or withdrawal forms prior to January 1, 1998 should submit claims for 1998 dates of service in accordance with the decision made. For 1998 enrollment and withdrawal forms received prior to January 1, 1998, update your participation files in conjunction with the installation of 1998 fees.
Participation Agreements Received After December 31, 1997
Although the participation enrollment period will run through February 2, 1998, the participation agreement is effective January 1, 1998. Physicians and practitioners who submit their 1998 participation election or withdrawal forms after December 31, 1997 must begin to bill in accordance with their decision once it is submitted to you. Enrollments and withdrawals for 1998 that are received after December 31, 1997 should be recorded within your system as soon as possible to ensure accurate processing of claims for 1998 services. Until such time as a timely filed 1998 participation election or withdrawal is received, use the providers 1997 participation status for processing 1998 claims.
Claims for dates of service on or after January 1, 1998 that are processed prior to your receipt of a participation election or withdrawal for 1998 should not routinely be reopened/reprocessed. However, if a physician requests you to reopen previously processed claims for dates of service on or after January 1, 1998 due to the impact of the extended enrollmenteriod, make accommodations for reopening such claims. Moreover, as of February 2, 1 998,teparticipafion status will be irrevocable for calendar year 1998 services.
Revised Due Date for Publishing Medicare Participating Physician/Supplier Directories and For Reporting Participation Data to HCFA
The date for publishing the 1998 Medicare Participating Physician/Supplier Director (MEDPARD) and for submitting the 1998 Participation Physician/Supplier report to HCFA is March 19, 1998.
Private Agreement Question and Answer Package
We are furnishing the Regional Offices (ROs) with a draft set of questions and answers on private agreements. The ROs will be instructed to share this information with you as soon as possible for your use in responding to inquiries. Because of the unofficial nature of this material, it should not be included in the participation enrollment package.
Once the question and answer package is officially approved, we will send this information to you via the ROs. Publish the final question and answer package no later than January 9, 1998 in either your next regularly scheduled bulletin or a special newsletter/bulletin, as appropriate.
If you incur additional costs based on this revision, you may submit a Supplemental Budget Request to your Regional Office.
This Program Memorandum may be discarded June 30, 1998.
Contact person for this PM is Melvia Page at (410) 786-4727.