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      Medicare: Participating vs. Non-Participating

      This article will go over Medicare participation status

      Medicare: Par vs. Non-Par

      The terms "par" and "non-par" refer to the relationship between providers and Medicare.

      • Par Providers (Participating Providers): These are healthcare providers who have agreed to accept Medicare’s approved amount for services as full payment. In Medicare, "participation" means you agree to always accept claims assignment for all covered services furnished to Medicare beneficiaries. By agreeing to always accept assignment, you agree to always accept Medicare allowed amounts as payment in full and not to collect more than the Medicare deductible and coinsurance or copayment from the beneficiary. For claims where assignment is accepted, the Medicare payment is sent to the supplier.

      • Non-Par Providers (Non-Participating Providers): These providers do not agree to accept Medicare's approved amount as full payment. Suppliers who choose not to sign the participation agreement are referred to as non-participating suppliers. The non-participating supplier can choose, on a claim-by-claim basis, whether to accept assignment or not. A claim that accepts assignment is treated the same as a participating provider and the payment is sent to the provider. When a non-participating supplier chooses to not accept assignment, the Medicare payment is sent directly to the beneficiary. Note: For Part B services (Must be a Medicare Part B provider, with a part B PTAN), providers can only charge up to 15% more than the Medicare-approved amount, known as the "limiting charge."

        *There is no limiting charge for Medicare DME (Durable Medical Equipment) Providers. DME providers do not have to abide by any cost-limiting rules put in place by Medicare. Medicare will still cover 80 percent of the Medicare-allowed amount, but these providers are able to charge any amount they choose for their services and are able to balance bill up to their charged amount, if they choose to not accept assignment*

      The key differences between participating and non-participating providers is the payment structure and the level of reimbursement a patient may receive. Non-par providers generally offer fewer protections for patients regarding out-of-pocket costs.