Part B Excess Charges

[yorkriver1]

Chiropractors cannot opt out of Medicare.

From CMS: http://www.cms.gov/Outreach-and-Edu...oducts/downloads/Chiropractors_fact_sheet.pdf

Should have clarified, I was using the chiro billing as an example, but my situation is an MD primary care doc. Good info about chiropractors and opting out, but, really? They have to be par or non par only?

I am more interested in the doc situation however. It seems the staff doesn't have the situation in hand, and the doc should know. I don't know how serious the trouble could be, but if CMS wanted to, it seems like it could be pretty big trouble if they are non-par and charging a lot more than the Medicare rate.

They don't want to be non-par if it means only the 9.5%. Their stated goal is to operate differently, charging almost $500 for a visit, spending 2 hours with a patient instead of 10-20 minutes. If they are going to make money, sounds like they need to opt out of Medicare, if they haven't already. That may turn off some Medicare patients, but seems the only compliant choice.

I am wondering now, since the call was answered: "This is _______ and I can help you", if the doc is using a generic phone receptionist service.

 

[sman]

If they are not accepting assignment or not balance billing only a small amount-15% of the 95% reimbursement rate=9.5%--learned that here....

It's actually 9.25%.

 

[WCMason]

Should have clarified, I was using the chiro billing as an example, but my situation is an MD primary care doc. Good info about chiropractors and opting out, but, really? They have to be par or non par only?

Par or non-par. No opt-out option. Don't know of any other provider type this applies to. Just a guess, but it sounds to me like CMS doesn't want them having any unauditable financial interaction with Medicare beneficiaries.

 

[Team Manning]

This is great, thank you!

 

[yorkriver1]

It's actually 9.25%.

Thanks, that would make the doc office even less likely to embrace the actual rules of "non-par".

How to bring this up...I just want to estimate the costs, not initiate a blow up to their practice model.
Will book time with the nutritionist, much lower hourly, where we know there's no reimbursement (no diabetes or kidney disease), diplomatically ask about the doc side once I am there, look at the forms they are handing out.

If there is no form stating that they have opted out of Medicare and claims won't be covered, and they can't explain how they bill so that the fees don't exceed allowable charges by the limiting charge, we'll see how that goes. I like them and wouldn't want to see them eventually get in trouble.

 

[sman]

Thanks, that would make the doc office even less likely to embrace the actual rules of "non-par".

How to bring this up...I just want to estimate the costs, not initiate a blow up to their practice model.
Will book time with the nutritionist, much lower hourly, where we know there's no reimbursement (no diabetes or kidney disease), diplomatically ask about the doc side once I am there, look at the forms they are handing out.

If there is no form stating that they have opted out of Medicare and claims won't be covered, and they can't explain how they bill so that the fees don't exceed allowable charges by the limiting charge, we'll see how that goes. I like them and wouldn't want to see them eventually get in trouble.

Just look them up on Medicare. That will tell you whether they accept assignment or not.

Medicare.gov Physician Compare Home

 

[somarco]

Psychologists (who are usually an MD) can opt out.

Here is a guide for opting out.

This is a good article from KFF on physician practices under Medicare.

I have been under the impression a concierge doc can opt out of Medicare unless they have/need admitting privileges to a par hospital.

 

[agentjhc]

Psychologists (who are usually an MD) can opt out.

Here is a guide for opting out.

This is a good article from KFF on physician practices under Medicare.

I have been under the impression a concierge doc can opt out of Medicare unless they have/need admitting privileges to a par hospital.

Psychologists are PH.D.
Psychiatrist M.D.

 

[somarco]

Psychologists are PH.D.
Psychiatrist M.D.

Never can get that right. Regardless, it is my impression many therapists (including Social Workers) opt out of Medicare so they can bill whatever they want.

 

[WCMason]

Never can get that right. Regardless, it is my impression many therapists (including Social Workers) opt out of Medicare so they can bill whatever they want.

I did find that an interesting part of the Kaiser Foundation article, that of the 1% opt our doctors, 42% are psychiatrists.