Demystifying PAR and Non-PAR: A Guide for Your Practice

The ever-evolving healthcare landscape can be confusing, especially when it comes to navigating Medicare regulations and reimbursement. Two terms that often trip up practice managers, healthcare providers, and owners are PAR (participating) and non-PAR (non-participating) status. This guide aims to demystify these terms and explain their implications for your practice.

Understanding PAR and Non-PAR Providers:
The Center for Medicare & Medicaid Services (CMS) governs the Medicare program, setting guidelines for physician participation. One of the key decisions for healthcare practices is choosing between becoming a PAR or non-PAR provider.

• PAR Providers: Physicians in this category agree to accept Medicare's approved fees as full payment for covered services. This typically benefits patients who pay only their deductible and coinsurance, with Medicare covering the remaining amount.
• Non-PAR Providers: These physicians choose not to accept Medicare's approved fees as full payment. They have the flexibility to set their own rates, which can exceed the Medicare-approved amount (limiting charge). Patients are responsible for the difference between what Medicare covers and the provider's fee.

Impact on Your Practice:
The choice between PAR and non-PAR status significantly affects your practice's operations:

• Revenue Cycle Management: PAR providers typically benefit from streamlined claims processing due to established relationships with Medicare. Non-PAR providers might face more complex billing procedures and require additional effort to collect patient payments.
• Financial Considerations: PAR providers can experience a steadier income stream from direct Medicare payments. However, they might face lower reimbursement rates. Non-PAR providers have the potential to earn higher fees, but may encounter challenges in collecting payments.
• Patient Flow: PAR providers may attract more patients due to potentially lower out-of-pocket costs. This can lead to higher patient volume and potentially longer wait times. Non-PAR providers might offer more scheduling flexibility, but patients may face higher out-of-pocket expenses.

Optimizing Your Revenue Cycle:
Understanding PAR and non-PAR status is crucial for optimal billing and revenue cycle management (RCM). Practices need efficient RCM systems to ensure timely and accurate claims submission, regardless of provider status.

Claims Med: Your Partner in Effective RCM
Navigating PAR and non-PAR options can be challenging. Claims Med offers expert medical billing and coding services to help your practice thrive under either arrangement. Our team can assist with:

• Understanding your specific needs: We can help you analyze your patient population and practice goals to determine the optimal PAR/non-PAR choice.
• Ensuring accurate claims submission: We handle the complexities of medical billing and coding, minimizing errors and maximizing reimbursements.
• Streamlining your RCM process: Claims Med offers proven strategies to improve efficiency and expedite revenue collection, regardless of your provider status.

Contact Claims Med today to discuss your specific needs and learn how we can streamline your billing process, optimize revenue collection, and make informed decisions about your Medicare participation status.