HCFA cites record highs in Medicare provider enrollment
The Medicare attendance roll took another leap in 1997, with 80.2% of health care practitioners enrolled, compared to 77.5% in 1996.
As an enrolled or participating contractor, physicians agree to accept only the Medicare payment, without any balance-billing to the patient. The actual number of participating physicians is now 691,000, up from 672,000 in 1996, according to statistics recently released by Department of Health and Human Services Secretary Donna Shalala.
Services provided by participating physicians now account for more than 92% of Medicare-allowed charges for physician services, Shalala says. A nonparticipating physician may charge up to 115% of the Medicare fee schedule amount. But, Medicare offers advantages, Shalala points out. The Medicare fee schedule is 5% less than for non-Medicare enrolled physicians. Also, provider enrollees can use toll-free lines to submit claims electronically, and they are included in a Medicare Participating Physician/Supplier Directory provided each year to beneficiaries.
In addition to physicians, nonphysician practitioners increased their enrollment as well from 93.1% in 1996 to 95.2%. This increase reflects the rising interest in hiring nonphysician practitioners, suggests Michael Powe, director of health systems and reimbursement for the American Academy of Physician Assistants in Alexandria, VA.
Following are names and telephone numbers of sources quoted in this issue:
• Coopers & Lybrand, Pittsburgh; Carol Serra, MHA, CRNP, national director of physician practice management services. Telephone: (412) 355-8039.
• Dean Medical Center, Madison, WI; John Vukish, MD, president, compensation committee. Telephone: (608) 282-2002.
• MD Anderson Cancer Center, Houston; Bernard Levin, MD, vice president for cancer prevention. Telephone: (713) 792-0803.
• Physician Payment Review Commission, Washington, DC. Telephone: (202) 653-7220.
• Rheinisch Medical Management, San Ramon, CA; Wanda Ziemba, senior consultant. Telephone: (510) 736-8411.
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