If you're a healthcare provider or patient going through Medicare, knowing the difference between Participating (PAR) and Non-Participating (Non-PAR) providers is crucial. With recent changes to Medicare in 2025, choosing correctly will affect healthcare reimbursement rates, administrative burden, and patient satisfaction.

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LATEST MEDICARE CHANGES: KEY DIFFERENCES FOR PAR VS. NON-PAR PROVIDERS

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LATEST MEDICARE CHANGES: KEY DIFFERENCES FOR PAR VS. NON-PAR PROVIDERS
Do you ever wonder why some medical providers accept Medicare assignments and others do
not?
Or why some physicians charge you more for the same services?
If you're a healthcare provider or patient going through Medicare, knowing the difference
between Participating (PAR) and Non-Participating (Non-PAR) providers is crucial. With recent
changes to Medicare in 2025, choosing correctly will affect healthcare reimbursement rates,
administrative burden, and patient satisfaction.
Read Detailed Blog : https://www.247medicalbillingservices.com/blog/latest-medicare-
changes-key-differences-for-par-vs-non-par-providers
What is a PAR Provider in Medical Billing?
A Participating (PAR) provider under Medicare will accept Medicare's approved rate as payment
in full for all covered services. This indicates that the provider will accept assignment so that
patients will only be asked to pay their required deductibles and coinsurance levels. PAR providers
usually have smoother billing procedures and faster Medicare reimbursements.

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What is a Non-PAR Provider in Medical Billing?
A Non-Participating (Non-PAR) provider can have the option to accept Medicare patients but does not
always commit to accepting Medicare's approved amount in full payment. These providers may choose to
accept assignments on a case-by-case basis or bill patients for an amount greater than the Medicare-
approved amount, subject to limiting charges. But they will have slower reimbursement and higher
administrative complexities.
Which is the Right Choice?
The decision to select PAR or non-PAR providers is based on the financial objectives of the practice and the
demographics of patients. PAR providers enjoy predictable, stable payments and reduced claims processing,
which suits them best to keep administrative loads at a minimum. Non-PAR providers might offer higher
prices but their billing functions are quite complicated to handle with delayed reimbursement possibilities.
Hospitals need to explore their Healthcare Practices Revenue Cycle Management solution requirements and
administrative capabilities together with patient needs before selecting a provider.
LATEST MEDICARE CHANGES: KEY DIFFERENCES FOR PAR VS. NON-PAR PROVIDERS

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Conclusion
The most recent adjustments to Medicare stand as evidence that professionals must master the difference
between PAR and non-PAR provider regulations. Providers may want to seek professional advice to navigate
such complexities and stay compliant. Outsourcing medical billing services to a trusted company like 24/7
Medical Billing Services can assist healthcare providers in achieving maximum reimbursements, minimizing
administrative hassles, and maintaining streamlined revenue cycles. Professional help ensures providers can
focus on providing quality patient care while maximizing their bottom line.
LATEST MEDICARE CHANGES: KEY DIFFERENCES FOR PAR VS. NON-PAR PROVIDERS

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Solution:
Providers should adopt electronic health record (EHR) systems designed for behavioral health
practices. Furthermore, automated templates and prompts can guide clinicians in meeting
documentation standards while reducing errors and omissions. Staff training programs
focused on documentation best practices are also critical for improving compliance.
3. Prior Authorization Hurdles
Prior authorization remains a significant roadblock in behavioral health billing. Insurers
frequently require approval for services such as therapy sessions, psychological testing, or
inpatient care. The process often involves lengthy paperwork and follow-ups, delaying both
care delivery and reimbursement.
Solution:
Designating a dedicated team to manage prior authorizations and using automated tools to track
authorization statuses can help providers stay ahead of approvals. Also, there is a need to ensure
timely renewals and address expirations proactively to reduce disruptions to patient care.

6. LATEST MEDICARE CHANGES: KEY DIFFERENCES FOR PAR VS. NON-PAR PROVIDERS
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FAQs
Q1. Can a provider modify their Medicare participation status?
Ans: Providers can switch between PAR and Non-PAR status once a year during the Medicare open
enrolment period.
Q2. How can a PAR provider transition to non-PAR status?
Ans: A PAR provider must send a signed letter on official letterhead to their Medicare contractor stating
their intent to opt-out.
Q3. Why do some providers prefer non-PAR status?
Ans: Non-PAR providers can charge patients up to 15% above Medicare-approved rates, giving them more
pricing flexibility.

7. LATEST MEDICARE CHANGES: KEY DIFFERENCES FOR PAR VS. NON-PAR PROVIDERS
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Q4. How does a non-PAR provider impact patient expenses?
Ans: Patients may have higher out-of-pocket costs since non-PAR providers can bill beyond the Medicare-approved
amount.
Q5. How do 2025 Medicare reimbursement changes affect providers?
Ans: A reduction in the Physician Fee Schedule (PFS) conversion factor diminishes the payments received by PAR and
Non-PAR medical providers.
Q6. Can non-PAR providers offer telehealth services in 2025?
Ans: Yes, but with restrictions—urban patients must visit clinical sites except for behavioral health services.
Q7. How do Medicare Advantage changes impact providers?
Ans: Medicare Advantage now covers mental health professionals, benefiting PAR providers while potentially reducing
patients for non-PAR providers.

8. LATEST MEDICARE CHANGES: KEY DIFFERENCES FOR PAR VS. NON-PAR PROVIDERS
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OM
Q8. Can a provider change their Medicare status mid-year?
Ans: No, the Medicare participation status of providers remains unchanged throughout
the entire year without any possible modifications.
Q9. What happens if a non-PAR provider overcharges beyond the limit?
Ans: Exceeding the 115% limiting charge violates Medicare rules and may result in
penalties or exclusion from the program.
Q10. How can providers offset reduced Medicare reimbursements in 2025?
Ans: PAR providers can use APCM codes for chronic care, while non-PAR providers
may renegotiate contracts with Medicare Advantage plans.

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LATEST MEDICARE CHANGES: KEY DIFFERENCES FOR PAR VS. NON-PAR PROVIDERS