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Special Medicare Notice Regarding 1995 Mandatory Assignment Changes for Nonparticipating Practitioners

Effective January 1, 1995, a change in Medicare law required certain practitioners to accept assignment for all covered services they furnish to Medicare beneficiaries. (The previous mandatory assignment requirement applied only to certain services furnished within the scope of the practitioner's particular specialty.) The following practitioners must accept assignment for all Medicare-covered services they furnish on or after January 1, 1995:

  • Clinical Nurse Specialists
  • Certified Registered Nurse Anesthetists
  • Certified Nurse Midwives
  • Clinical Social Workers
  • Clinical Psychologists
  • Nurse Practitioners
  • Physician Assistants
  • Registered Dietitians and Nutrition Professionals

As a result of this change in Medicare law, we are not sending you an enrollment package of instructions for entering into or withdrawing from the Medicare Participation Program (i.e., an agreement to accept assignment in all cases) for calendar year 1995 and subsequent years.

Although you will no longer be invited to officially enroll in the Medicare Program, you will be treated as a participating practitioner for purposes of various benefits available under the program. These benefits are listed below:

  1. When you provide and bill for assigned services outside the scope of your practitioner benefit (e.g., when you provide diagnostic tests paid for under the Medicare physician fee schedule) there will be no five percent reduction in the Medicare approved amount.
  2. You will have "one stop" billing for beneficiaries who also have non-employment related Medigap coverage. This "one stop" billing provision applies only when the beneficiary has assigned both Medicare and Medigap payments to you. After we have made payment on a "one stop" billing claim, we automatically send the claim on to Medigap insurer for payment on all coinsurance and deductible amounts due under the Medigap policy. The Medigap insurer must pay you directly.
  3. Those practitioners or practitioner groups who independently submit claims to Medicare will be listed in a separate section of the Medicare Participating Physician Directory at www.medicare.gov/physician/home.aspExternal Website.

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