Form Cms-46 - Medicare Participating Physician And Supplier Agreement (Page 3 of 4) in pdf

DEPARTMENT OF HEALTH AND HUMAN SERVICES

CENTERS FOR MEDICARE & MEDICAID SERVICES

INSTRUCTIONS

For the Medicare Participating Physician and Supplier Agreement (CMS-460)

To sign a participation agreement is to agree to accept assignment for all covered services that you provide to

Medicare patients.

WHY PARTICIPATE?

If you bill for physicians’ professional services, services and supplies provided incident to physicians’ professional

services, outpatient physical and occupational therapy services, diagnostic tests, or radiology services, your

Medicare fee schedule amounts are 5 percent higher if you participate. Also, providers receive direct and

timely reimbursement from Medicare.

Regardless of the Medicare Part B services for which you are billing, participants have “one stop” billing for

beneficiaries who have Medigap coverage not connected with their employment and who assign both their

Medicare and Medigap payments to participants. After we have made payment, Medicare will send the claim

on to the Medigap insurer for payment of all coinsurance and deductible amounts due under the Medigap policy.

The Medigap insurer must pay the participant directly.

Currently, the large majority of physicians, practitioners and suppliers are billing under Medicare participation

agreements.

WHEN THE DECISION TO PARTICIPATE CAN BE MADE:

• Toward the end of each calendar year, all Medicare carriers have an open enrollment period. T he open

enrollment period generally is from mid-November through December 31. During this period, providers

who are currently enrolled in the Medicare Program can change their current participation status beginning

the next calendar year on January 1. This is the only time these providers are given the opportunity to

change their participation status. These providers should contact their local Medicare carrier to learn

where to send the agreement, and get the exact dates for the open enrollment period when the agreement

will be accepted.

• New physicians, practitioners, and suppliers can sign the participation agreement and become a

Medicare participant at the time of their enrollment into the Medicare Program. The participation

agreement will become effective on the date of filing; i.e., the date the participant mails (post-mark

date) the agreement to the carrier or delivers it to the carrier.

Contact your Medicare carrier to get the exact dates the participation agreement will be accepted, and

to learn where to send the agreement.

WHAT TO DO DURING OPEN ENROLLMENT:

If you choose to be a participant:

• Do nothing if you are currently participating, or

• If you are not currently a Medicare participant, complete the blank agreement (CMS-460) and mail it

(or a copy) to each carrier to which you submit Part B claims. (On the form show the name(s) and

identification number(s) under which you bill.)

If you decide not to participate:

• Do nothing if you are currently not participating, or

• If you are currently a participant, write to each carrier to which you submit claims, advising of your

termination effective the first day of the next calendar year. This written notice must be postmarked

prior to the end of the current calendar year.

Form CMS-460 Instructions (03/06)

Form Cms-46 - Medicare Participating Physician And Supplier Agreement Page 3