Date: Friday, May 17, 1996
FOR IMMEDIATE RELEASE
Contact: HCFA Press Office (202)690-6145

PRACTITIONER ENROLLMENT IN MEDICARE PROGRAM INCREASES FOR 1996

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:

• For MDs and doctors of osteopathy, the participation rate increased to 80 percent in 1996, up from 74.6 percent in 1995.
• For limited license practitioners, who are optometrists, podiatrists, chiropractors or oral surgeons, the participation rate rose to 50.3 percent, compared with 44.6 percent in 1995.
• For nonphysician practitioners, the participation rate increased to 93.1 percent in 1996 from 91.6 percent in 1995.

"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:

• 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 RATES BY STATE

(Enrollment by percent for MDs and other practitioners)