Re: Medicare

[Guest guest]

My understanding, (correct me if I am wrong folks).....

If you collect any money directly from a medicare patient without first billing medicare, you could be considered a non-participating physician for at least 3 years. This could be a good or bad thing depending on how you feel about being a participating provider.

But it is not illegal. It might be considered fraudulent if you collect money from one patient, yet bill as a participating provider for another.

TAS

-----Original Message-----From: M. Wilterding Sent: Thursday, May 27, 2004 9:59 PMTo: Subject: Medicare

I still don't have all of my medicare set up, but have recently been contacted by a person with medicare who wants to be in my practice and is willing to pay cash at time of service until I can bill medicare (sounds a bit odd, huh?). An office manager in another practrice where I've been doing locums work thinks that this is illegal. Anyone know about it?

james

[Guest guest]

I believe holding on to the claims until

you get your number is the best idea. If I remember right, medicare will

reimburse you for any visits done between the time of the initial application

and the time you get your provider number. Obviously, this is not the most

efficient way of doing the billing, but it will save you from many other

possible issues down the road.

Medicare

I still don't have all of my

medicare set up, but have recently been contacted by a person with medicare who

wants to be in my practice and is willing to pay cash at time of service until

I can bill medicare (sounds a bit odd, huh?). An office manager in another practrice

where I've been doing locums work thinks that this is illegal. Anyone

know about it?

james

[Guest guest]

If I am not mistaken, with regard to Medicare (and like no other form of insurance), you must do one of three things:

1. become a "participating" provider (i.e. agree to Medicare's reimbursement for all covered care),

2. become a "non-participating" provider (i.e. you may pick and choose who you take assignment on, but the reimbursement is less), OR

3. opt-out of Medicare [which means you may charge patients whatever you want, but you may not bill Medicare for any care except emergencies and you must opt-out for 2 years at a time (but the application to opt-out can only be accepted quarterly on the first of Jan, April, July and Oct) AND you may not participate in one practice and opt-out in another (if you opt-out in one, you are considered to have "opted-out" in all practices) AND the patient may not submit a claim for reimbursement either!!]

I don't have to opt-out of any other insurance plan(s), I can participate in one plan where I "moonlight" in a local ER and not participate with any plans at my office and, my patient or I may submit claims on behalf of the patient for reimbursement (out of network reimbursement, usually) and there is no time requirements (if I wish to participate in BC/BS I can send in an application at any time). This is obviously an attempt by our government to coerce us to participate (as a "participating" or "non-participating" provider) in an underpaying insurance plan. Not to mention the fact that nearly 25% of those with Medicare in my area are "disabled." Which means if I sign up as a provider I will be inundated with several patients a day that have convinced someone that they "can't work" and think they need narcotics and other controlled substances just to live (but, alas, that is another subject!).

I understand that most of the local carriers will allow you to bill for care provided by you to Medicare patients retroactively to the date you sent in your application, but as others have said, it would be wise to check with your local carrier.

D. , MD

solo since Feb 2004, cash only (except possibly Medicare, not decided yet), open-access appointments

Charting Plus EMR, no billing software (since I'm trying to do this cash-only)

[Guest guest]

Thanks for all of the replies on this issue - it has been invaluable to my decision process.

Re: Medicare

If I am not mistaken, with regard to Medicare (and like no other form of insurance), you must do one of three things:

1. become a "participating" provider (i.e. agree to Medicare's reimbursement for all covered care),

2. become a "non-participating" provider (i.e. you may pick and choose who you take assignment on, but the reimbursement is less), OR

3. opt-out of Medicare [which means you may charge patients whatever you want, but you may not bill Medicare for any care except emergencies and you must opt-out for 2 years at a time (but the application to opt-out can only be accepted quarterly on the first of Jan, April, July and Oct) AND you may not participate in one practice and opt-out in another (if you opt-out in one, you are considered to have "opted-out" in all practices) AND the patient may not submit a claim for reimbursement either!!]

I don't have to opt-out of any other insurance plan(s), I can participate in one plan where I "moonlight" in a local ER and not participate with any plans at my office and, my patient or I may submit claims on behalf of the patient for reimbursement (out of network reimbursement, usually) and there is no time requirements (if I wish to participate in BC/BS I can send in an application at any time). This is obviously an attempt by our government to coerce us to participate (as a "participating" or "non-participating" provider) in an underpaying insurance plan. Not to mention the fact that nearly 25% of those with Medicare in my area are "disabled." Which means if I sign up as a provider I will be inundated with several patients a day that have convinced someone that they "can't work" and think they need narcotics and other controlled substances just to live (but, alas, that is another subject!).

I understand that most of the local carriers will allow you to bill for care provided by you to Medicare patients retroactively to the date you sent in your application, but as others have said, it would be wise to check with your local carrier.

D. , MD

solo since Feb 2004, cash only (except possibly Medicare, not decided yet), open-access appointments

Charting Plus EMR, no billing software (since I'm trying to do this cash-only)