Date: May 8, 1995
FOR IMMEDIATE RELEASE
Contact: HCFA Press Office (202) 690-6145

Practitioner Enrollment in Medicare Program Increases for 1995

Nearly three-quarters of the physicians and other practitioners who serve Medicare beneficiaries have enrolled in the Medicare participating physician program for 1995, HHS Secretary Donna E. Shalala announced today.

The overall rate of participation is 72.3 percent this year, up from 64.8 percent in 1994. The actual number of enrollees in the program increased to 620,000 in 1995 from 578,000 last year.

Participation rose in all states except Rhode Island.

"This program is important for Medicare beneficiaries," Secretary Shalala said. "By choosing a participating physician, a beneficiary will not be burdened with charges in excess of Medicare-approved amounts."

Participation has risen every year since the program started in 1984. The overall rate includes medical doctors (MDs), limited license practitioners and nonphysician practitioners:

• For MDs and doctors of osteopathy, the participation rate increased to 74.6 percent in 1995, up from 71.9 percent in 1994.
  
  
• For limited license practitioners, who are optometrists, podiatrists, chiropractors or oral surgeons, the participation rate rose to 44.6 percent, compared with 42.8 percent in 1994.
  
  
• For nonphysician practitioners, the participation rate increased to 91.6 percent in 1995 from 51.7 percent in 1994.

A change in the Medicare law, effective Jan. 1, requires some nonphysician practitioners to accept assignment for all covered services. The practitioners covered by this change are certified registered nurse anesthetists, physician assistants, nurse practitioners, nurse midwives, clinical nurse specialists, clinical psychologists and clinical social workers.

This was the key factor behind the 1995 increase in the overall participation rate. All these practitioners are now treated as participants. As a result, the participation rate for this group rose from 53.5 percent in 1994 to 100 percent in 1995, accounting for about three-quarters of the total increase in the program.

"Even without this increase, the participation rate would still have gone up by 2.1 percentage points for 1995," said Bruce C. Vladeck, administrator of the Health Care Financing Administration, which manages the Medicare program. "Other reasons for the increase in the enrollment of participating physicians include our continuing efforts both to explain the program's benefits to beneficiaries and to enforce the limit on the charges made by nonparticipating physicians."

The nonphysician practitioners not covered by the Jan. 1 change are audiologists, physical therapists, psychologists and occupational therapists.

A participating physician agrees to accept Medicare fee schedule amounts as full payment for Medicare services.

"Services provided by participating physicians now account for almost 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.

Physicians are advised that participating in the program creates the following advantages:

• Their Medicare fee schedule is 5 percent higher than that of nonparticipating physicians.
  
  
• They are provided with toll-free lines if they submit claims electronically.
  
  
• Their names are listed in the Medicare Participating Physician/Supplier Directory, which is furnished to senior citizen groups.

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 Data by State
(Enrollment by percent for MDs and other practitioners)

###