Non-participating is new normal

 - 
Friday, January 18, 2019

YARMOUTH, Maine – It turns out a good chunk of the respondents to a recent HME Newspoll didn’t change their enrollment status by a Dec. 31 deadline because they’re already non-participating.

Industry stakeholders had been encouraging providers to enroll as non-participating providers so they can take assignment on a claim-by-claim basis.

“Always have been and always will be non-par,” wrote Sarah Cotner, a provider in Kokomo, Ind. “I want to be able to offer my patient the option of ‘good, better, best.’ If they want ‘good,’ we will accept assignment. If they want ‘better’ or ‘best,’ we will bill non-assigned, so they can at least get reimbursed the allowed amount.”

Sixty-six percent of the respondents who said they didn’t change their enrollment status for 2019 said they were non-participating.

Respondents say they need this flexibility primarily due to reduced reimbursement from Medicare’s competitive bidding program.

“I need the option to decide whether to go assignment or non-assignment depending on the item and what Medicare pays for the item,” wrote one respondent.

But even respondents who have been non-participating for years say they will be taking an even harder line about what Medicare business they accept.

“We have been non-participating for years, but almost always accept assignment,” said Lori Sears, a provider in Lapeer, Mich. “This year, we are going to try billing non-assigned on may purchases items and see how it goes with patients and referrals. If they don’t accept it, we will reject most Medicare referrals.”

If one respondent’s experience is any indication, patients and referrals will understand the position of providers.

“When I explain to a caller that we aren’t a participating Medicare provider, the answer is almost always the same: ‘I don’t blame you,’” wrote Brian Keith, a provider in Greensboro, N.C.

There is, however, one scenario in which providers might have their hands tied.

“We are part of a larger health system and we share the same tax ID number with our home health agency and by going non-participating we would impact them negatively with reimbursement,” wrote one respondent who is still a participating provider.