Changing Your Medicare Enrollment Status

APA's Managed Care Help Line receives frequent calls from psychiatrists who are unsure about what steps to take with Medicare when they change their practice situations. According to the Help Line's contacts at the Centers for Medicare and Medicaid Services, there's not much to it.

The most frequent situation that arises is that of a psychiatrist who works at a clinic or other facility where he or she sees Medicare patients and wants to start a private practice where Medicare patients will be seen as well. In this case, the psychiatrist needs to contact the enrollment office of the Medicare carrier or administrative contractor that serves the locale where the psychiatrist practices and update his or her information with the new practice address. If the new practice is incorporated, the psychiatrist must also supply its name and register for a Type 2 NPI for the new entity at the NPPES Web site at<https://nppes.cms.hhs.gov/NPPES/Welcome.do>. The provider's Type 1 NPI stays the same, but payments will be made to the corporation using the new NPI.

Some psychiatrists who see Medicare patients in a clinic or hospital setting do not want to deal with Medicare when they start a private practice. Since they will be continuing to see Medicare patients at the facility where they work, they cannot opt out of Medicare. Thus, if they see any Medicare patients in their private practice (even if it's unintentional), they must file claims with Medicare for them and correct their enrollment status with Medicare to get paid.

More information on opting out of Medicare is posted at<http://psych.org/MainMenu/PsychiatricPractice/ManagingYourPractice/QuickPracticeInfo/MedicareOptOut.aspx>.▪