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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References in periodicals archive ?
OFF., 1202 (1998), https://www.gpo.gov/fdsys/pkg/GPO-CPRT-105WPRT37945/pdf/GPO-CPRT105WPRT37945-3-5.pdf (balancing the limit of the amount a nonparticipating physician can charge a beneficiary); Participating vs.
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. What is clear is that Medicare is expecting all enrolled physicians to employ electronic record-keeping and billing practices (EMRs) and that such technology must be in place by 2014.
Like many other retainer practitioners, he doesn't deal with insurance, except to bill for vaccines as a nonparticipating physician.
(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.
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.
For physicians nonparticipating in Medicare, in Medicare payment locality 2 in Florida, the reimbursement for the base code of colonoscopy (code 45378) is the Medicare "limited charge" of $306.59.[11] The limited charge represents the upper legal limit that a nonparticipating physician can charge on unassigned claims to Medicare beneficiaries.[11] This base value is built into both of the two higher valued codes: ie, the base code limited charge of $306.59 is included in the limited charge for the colonoscopy with biopsy (code 45380, with a Medicare limited charge of $338.32) and in the limited charge for the colonoscopy with polypectomy (code 45385, with a Medicare limited charge of $510.17).[11]
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.
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.
(A) In general.--In the case of a nonparticipating physician or nonparticipating supplier or other person (as defined in section 1842(i)(2)) who does not accept payment on an assignment-related basis for a physician's service furnished with respect to an individual enrolled under this part, the following rules apply: (i) Application of limiting charge.--No person may bill or collect an actual charge for the service in excess of the limiting charge described in paragraph (2) for such service.