nonparticipating physician

non·par·ti·ci·pat·ing phy·si·cian

(non'par-tis'i-pāt-ing fi-zish'ŭn)
In the U.S. Medicare program, a physician who does not accept assignment on all Medicare claims.
Synonym(s): nonPAR.
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100) The nonparticipating physician has less opportunity to reap a steady stream of senior patients--a stream that would positively inure to the overall revenues of the physician's business.
Also, the limitation of liability provision does not apply to Medical Insurance services provided by a nonparticipating physician or supplier who did not accept assignment of the claim.
It is also not clear if this policy prohibits a specialist from accepting a referral from a nonparticipating physician.
Like many other retainer practitioners, he doesn't deal with insurance, except to bill for vaccines as a nonparticipating physician.
3 percent will remain a Medicare nonparticipating physician
It is estimated that a nonparticipating physician must collect the entire limiting charge roughly 35% of the time for the same service, as compared to participating physicians, in order to break even with participating physicians.
Maves also said in the letter that physicians nationwide have been reporting that they received Aetna Explanation of Benefits (EOB) forms stating that the patient has no obligation to pay the nonparticipating physician the difference between the physician's charge and the amount that Aetna has paid.
Maves also said in the letter that physicians nationwide are reporting receiving Aetna Explanation of Benefits (EOB) forms stating that the patient has no obligation to pay the nonparticipating physician the difference between the physician's charge and the amount Aetna has paid.
Maves also noted in the letter that physicians nationwide are reporting receiving Aetna explanation of benefits (EOB) forms stating that the patient has no obligation to pay the nonparticipating physician the difference between the physician's charge and the amount Aetna has paid.
11] The limited charge represents the upper legal limit that a nonparticipating physician can charge on unassigned claims to Medicare beneficiaries.
Next year, in a significant expansion of the Maximum Allowable Actual Charge (MAAC) concept, Medicare will phase in an absolute ceiling on the amount a nonparticipating physician can charge a Medicare beneficiary on an unassigned claim.
The site is open to health care professionals, as well as office staff in nonparticipating physician offices, hospitals and ancillary facilities, who have submitted a claim or a W-9 form to Aetna.