MEDICAL ECONOMICS
A tough call Leaving Medicare tempting, but possibly costly BY KEN ORTOLON Frisco family physician Chris Noyes, MD,
says he had a “straw that broke the camel’s back moment” with Medicare in 2009. “I had a patient who moved from out of state to be with his kids. He had lung cancer when he came in, and when he died, we wrote off a fairly large balance because I didn’t think it was right to charge his estate,” Dr. Noyes said. “Two years after he died, we got a letter from Medicare saying they had overpaid for a flu shot for him by $2 and they wanted the money back with interest and a penalty, and if I didn’t pay it all within 30 days, they would pros- ecute me.” Dr. Noyes says he already had
considered opting out of Medicare because of low pay and increasing hassles. Staying in the program “just didn’t make sense business- wise,” he said. “We get paid less for seeing a Medicare patient than we do for doing the same thing for a private insurance patient, and the patients are more com- plicated. You have to spend more time with them.” But Dr. Noyes says he stayed in
Medicare out of “a desire to serve the community.” That changed af- ter he received the $2 threatening letter. He opted out of Medicare in early 2009.
into a private-pay agreement with Medicare patients who de- cide to stay with the practice “so that they clearly understand that the services that you are going to be providing are not reimbursable under the Medicare program.” Dr. Noyes says he offers Medi-
“The charade of Congress ‘fixing’ the SGR problem has gone on long
enough. I think some doctors have just given up and may resort to a cash-
only primary care practice.”
After consulting the Texas Medical Association Knowledge
Center, he sent letters to all of his Medicare patients telling them he would stop accepting Medicare in 90 days. Physicians who opt out of Medicare need to make sure they notify their Medicare patients of their decision. Genevieve Davis, director of TMA’s Payment Advocacy De- partment, says Medicare requires opted-out physicians to enter
care patients who stayed in his practice a discount similar to other patients who pay cash at the time of service. And Angleton family physician Su Zan Carpen- ter, MD, who also opted out of Medicare in 2011, says she bases rates for Medicare patients who remained in her practice on the Medicare fee schedule.
Drs. Noyes and Carpenter are among a small but growing num- ber of physicians across the coun- try who have opted out of Medi- care, which means their Medicare patients either have to find a new doctor or pay for that physician’s services out of their own pocket. While Dr. Noyes says his deci- sion to opt out made good busi- ness sense for him, TMA officials warn that physicians need to take a close look at their practices and consider a number of potential pitfalls before they take that step.
Opt out vs. “nonpar” Formally opting out of Medicare means a physician cannot bill Medicare at all for the care he or
she provides a Medicare beneficiary. And Medicare will not reimburse a patient for any out-of-pocket expenses incurred in seeing an opted-out physician. There are exceptions for emer- gency services.
Physicians who opt out of Medicare must do so for two years. Then they must decide if they want to opt out for an- other two years or rejoin the program.
July 2012 TEXAS MEDICINE 27
Page 1 |
Page 2 |
Page 3 |
Page 4 |
Page 5 |
Page 6 |
Page 7 |
Page 8 |
Page 9 |
Page 10 |
Page 11 |
Page 12 |
Page 13 |
Page 14 |
Page 15 |
Page 16 |
Page 17 |
Page 18 |
Page 19 |
Page 20 |
Page 21 |
Page 22 |
Page 23 |
Page 24 |
Page 25 |
Page 26 |
Page 27 |
Page 28 |
Page 29 |
Page 30 |
Page 31 |
Page 32 |
Page 33 |
Page 34 |
Page 35 |
Page 36 |
Page 37 |
Page 38 |
Page 39 |
Page 40 |
Page 41 |
Page 42 |
Page 43 |
Page 44 |
Page 45 |
Page 46 |
Page 47 |
Page 48 |
Page 49 |
Page 50 |
Page 51 |
Page 52 |
Page 53 |
Page 54 |
Page 55 |
Page 56 |
Page 57 |
Page 58 |
Page 59 |
Page 60 |
Page 61 |
Page 62 |
Page 63 |
Page 64 |
Page 65 |
Page 66 |
Page 67 |
Page 68