Professionals Eligible to Participate But Not Able to Participate

20.1.1 – Professionals Eligible to Participate But Not Able to Participate (Rev. 10, Issued: 07-27-12, Effective: 10-29-12, Implementation: 10-29-12) Some professionals who are included in the definition of “eligible professional” above are eligible to participate but are not able to participate for one or more reasons. These include: eligible professionals in certain settings in which Medicare Physician Fee Schedule billing is processed by Medicare fiscal intermediaries (FIs)/AB Medicare Administrative Contractors (MACs). The FI/MAC claims processing systems for the following settings currently cannot accommodate billing at the individual eligible professional level: • Critical access hospitals (CAHs), method II payment, where the physician or practitioner has reassigned his or her benefits to the CAH. In this situation, the CAH bills the regular FI or Part A MAC for the covered professional services furnished by the eligible professional. 5 • All institutional providers that bill for outpatient therapy provided by physical and occupational therapists and speech language pathologists (for example, hospital, skilled nursing facility Part B, home health agency, comprehensive outpatient rehabilitation facility, or outpatient rehabilitation facility). This does not apply to skilled nursing facilities under Part A.