RE: Non participating Medicare Provider

[Guest guest]

I guess you are not seeking new Medicare patients so my next question is

sort of irrelevant in your case, but isn't it possible that by being

non-participating that you are more than canceling out that little bit of

extra upfront income & ease by the large numbers of Medicare patients that

never even come to you because of that policy? In other words, you might

collect upfront on 200 pt's but lose 600 other Medicare pt's? As I've

mentioned before though, I guess that works (as does just about anything) if

your panel is small enough, and it sounds like you are running a very low

volume practice if you only have 200 Medicare pt's. Medicare billing is a

hassle but I'm certain I could not survive without taking that & staying

open to them. That is bar far my biggest payor. That still really

surprises me though that someone would pay into Medicare their entire

working life & then agree to pay out of pocket. I personally would

definitely not agree to that when I'm 65, no matter how good my doctor is,

but all of us approach things differently. All I can say is you must be a

great doctor to keep those 200 Medicare pt's that are willing to pay put of

pocket.

Update and questions

> >>

> >>

> >>

> >> Hi All. Thought I'd continue the update chain and I've got a

> >> question or two for you.

> >>

> >> First, I'm one month in to my solo practice and have been mostly

> >> pleased. There have been some conflicts with my " roommates, " which

> >> include another doc (from whom I'm renting space) and our shared

> >> staff. Some of those conflicts are making me reconsider the rent

> >> part of the low-cost model and moving into my own space. While my

> >> expenses will increase, I will be better able to initiate office

> >> systems, EMRs, etc. -- which is more difficult as a solo practice

> >> moving into an established office that is resistant to change.

> >>

> >> My question is regarding practice size. What are some milestones

> >> you've had regarding number of patients? One month? One year?

> >> Have you been satisfied with your progress?

> >>

> >> Thanks.

> >>

> >> Brad

> >>

> >>

> >>

> >>

> >>

> >>

> >>

> >>

> >> YAHOO! GROUPS LINKS

> >>

> >> Visit your group " " on the web.

> >>

> >>

[Guest guest]

I guess you are not seeking new Medicare patients so my next question is

sort of irrelevant in your case, but isn't it possible that by being

non-participating that you are more than canceling out that little bit of

extra upfront income & ease by the large numbers of Medicare patients that

never even come to you because of that policy? In other words, you might

collect upfront on 200 pt's but lose 600 other Medicare pt's? As I've

mentioned before though, I guess that works (as does just about anything) if

your panel is small enough, and it sounds like you are running a very low

volume practice if you only have 200 Medicare pt's. Medicare billing is a

hassle but I'm certain I could not survive without taking that & staying

open to them. That is bar far my biggest payor. That still really

surprises me though that someone would pay into Medicare their entire

working life & then agree to pay out of pocket. I personally would

definitely not agree to that when I'm 65, no matter how good my doctor is,

but all of us approach things differently. All I can say is you must be a

great doctor to keep those 200 Medicare pt's that are willing to pay put of

pocket.

Update and questions

> >>

> >>

> >>

> >> Hi All. Thought I'd continue the update chain and I've got a

> >> question or two for you.

> >>

> >> First, I'm one month in to my solo practice and have been mostly

> >> pleased. There have been some conflicts with my " roommates, " which

> >> include another doc (from whom I'm renting space) and our shared

> >> staff. Some of those conflicts are making me reconsider the rent

> >> part of the low-cost model and moving into my own space. While my

> >> expenses will increase, I will be better able to initiate office

> >> systems, EMRs, etc. -- which is more difficult as a solo practice

> >> moving into an established office that is resistant to change.

> >>

> >> My question is regarding practice size. What are some milestones

> >> you've had regarding number of patients? One month? One year?

> >> Have you been satisfied with your progress?

> >>

> >> Thanks.

> >>

> >> Brad

> >>

> >>

> >>

> >>

> >>

> >>

> >>

> >>

> >> YAHOO! GROUPS LINKS

> >>

> >> Visit your group " " on the web.

> >>

> >>

[Guest guest]

,

Medicare reimbursement is only going to decline as our administrative burdens

go up (just can't wait to add the burden of P4P!!) as our costs, no matter how

low overhead we are, go up. Medicare is not one of my better payers, and the

patients are generally much higher maintenance by virtue of age. I consider

this to be part of my indigent care, unfortunately. I am planning for the

future by being a non-participating doctor.

I currently have a patient panel of about 1000 patients, so Medicare

constitutes only a small portion of my patient panel.

I sometimes wonder with your postings if you are underestimating your

patients, underestimating the value of your care to your patients, or both. I

suspect they would surprise you if you gave them a chance.

Being only 37 years old, I will have paid a tremendous amount into Medicare by

age 65, but I sincerely doubt that Medicare as we know it will be around when

I am 65, so I consider my contributions not for myself, but for the current

system. I do not anticipate benefitting from my Medicare contributions.

Take care,

, MD

Durango, CO

On Fri, 7 Apr 2006 08:13:06 -0400

" Brock DO " wrote:

> I guess you are not seeking new Medicare patients so my next question is

> sort of irrelevant in your case, but isn't it possible that by being

> non-participating that you are more than canceling out that little bit of

> extra upfront income & ease by the large numbers of Medicare patients that

> never even come to you because of that policy? In other words, you might

> collect upfront on 200 pt's but lose 600 other Medicare pt's? As I've

> mentioned before though, I guess that works (as does just about anything) if

> your panel is small enough, and it sounds like you are running a very low

> volume practice if you only have 200 Medicare pt's. Medicare billing is a

> hassle but I'm certain I could not survive without taking that & staying

> open to them. That is bar far my biggest payor. That still really

> surprises me though that someone would pay into Medicare their entire

> working life & then agree to pay out of pocket. I personally would

> definitely not agree to that when I'm 65, no matter how good my doctor is,

> but all of us approach things differently. All I can say is you must be a

> great doctor to keep those 200 Medicare pt's that are willing to pay put of

> pocket.

>

>

>

> Update and questions

> > >>

> > >>

> > >>

> > >> Hi All. Thought I'd continue the update chain and I've got a

> > >> question or two for you.

> > >>

> > >> First, I'm one month in to my solo practice and have been mostly

> > >> pleased. There have been some conflicts with my " roommates, " which

> > >> include another doc (from whom I'm renting space) and our shared

> > >> staff. Some of those conflicts are making me reconsider the rent

> > >> part of the low-cost model and moving into my own space. While my

> > >> expenses will increase, I will be better able to initiate office

> > >> systems, EMRs, etc. -- which is more difficult as a solo practice

> > >> moving into an established office that is resistant to change.

> > >>

> > >> My question is regarding practice size. What are some milestones

> > >> you've had regarding number of patients? One month? One year?

> > >> Have you been satisfied with your progress?

> > >>

> > >> Thanks.

> > >>

> > >> Brad

> > >>

> > >>

> > >>

> > >>

> > >>

> > >>

> > >>

> > >>

> > >> YAHOO! GROUPS LINKS

> > >>

> > >> Visit your group " " on the web.

> > >>

> > >>

[Guest guest]

,

Medicare reimbursement is only going to decline as our administrative burdens

go up (just can't wait to add the burden of P4P!!) as our costs, no matter how

low overhead we are, go up. Medicare is not one of my better payers, and the

patients are generally much higher maintenance by virtue of age. I consider

this to be part of my indigent care, unfortunately. I am planning for the

future by being a non-participating doctor.

I currently have a patient panel of about 1000 patients, so Medicare

constitutes only a small portion of my patient panel.

I sometimes wonder with your postings if you are underestimating your

patients, underestimating the value of your care to your patients, or both. I

suspect they would surprise you if you gave them a chance.

Being only 37 years old, I will have paid a tremendous amount into Medicare by

age 65, but I sincerely doubt that Medicare as we know it will be around when

I am 65, so I consider my contributions not for myself, but for the current

system. I do not anticipate benefitting from my Medicare contributions.

Take care,

, MD

Durango, CO

On Fri, 7 Apr 2006 08:13:06 -0400

" Brock DO " wrote:

> I guess you are not seeking new Medicare patients so my next question is

> sort of irrelevant in your case, but isn't it possible that by being

> non-participating that you are more than canceling out that little bit of

> extra upfront income & ease by the large numbers of Medicare patients that

> never even come to you because of that policy? In other words, you might

> collect upfront on 200 pt's but lose 600 other Medicare pt's? As I've

> mentioned before though, I guess that works (as does just about anything) if

> your panel is small enough, and it sounds like you are running a very low

> volume practice if you only have 200 Medicare pt's. Medicare billing is a

> hassle but I'm certain I could not survive without taking that & staying

> open to them. That is bar far my biggest payor. That still really

> surprises me though that someone would pay into Medicare their entire

> working life & then agree to pay out of pocket. I personally would

> definitely not agree to that when I'm 65, no matter how good my doctor is,

> but all of us approach things differently. All I can say is you must be a

> great doctor to keep those 200 Medicare pt's that are willing to pay put of

> pocket.

>

>

>

> Update and questions

> > >>

> > >>

> > >>

> > >> Hi All. Thought I'd continue the update chain and I've got a

> > >> question or two for you.

> > >>

> > >> First, I'm one month in to my solo practice and have been mostly

> > >> pleased. There have been some conflicts with my " roommates, " which

> > >> include another doc (from whom I'm renting space) and our shared

> > >> staff. Some of those conflicts are making me reconsider the rent

> > >> part of the low-cost model and moving into my own space. While my

> > >> expenses will increase, I will be better able to initiate office

> > >> systems, EMRs, etc. -- which is more difficult as a solo practice

> > >> moving into an established office that is resistant to change.

> > >>

> > >> My question is regarding practice size. What are some milestones

> > >> you've had regarding number of patients? One month? One year?

> > >> Have you been satisfied with your progress?

> > >>

> > >> Thanks.

> > >>

> > >> Brad

> > >>

> > >>

> > >>

> > >>

> > >>

> > >>

> > >>

> > >>

> > >> YAHOO! GROUPS LINKS

> > >>

> > >> Visit your group " " on the web.

> > >>

> > >>

[Guest guest]

I have recently received a few Medicare transfer pt's from another somewhat

nearby doctor that decided to go " non participating. " They did not want any part

of that. I'm not sure just how many of his Medicare pt's are leaving, but I'm

sure a lot will. I'm sure close to 90% of my Medicare pt's would go elsewhere

if I became non participating.

>

>

> Date: 2006/04/07 Fri PM 07:09:20 EDT

> To:

> Subject: Re: Non participating Medicare Provider

>

> ,

> Medicare reimbursement is only going to decline as our administrative burdens

> go up (just can't wait to add the burden of P4P!!) as our costs, no matter how

> low overhead we are, go up. Medicare is not one of my better payers, and the

> patients are generally much higher maintenance by virtue of age. I consider

> this to be part of my indigent care, unfortunately. I am planning for the

> future by being a non-participating doctor.

>

> I currently have a patient panel of about 1000 patients, so Medicare

> constitutes only a small portion of my patient panel.

>

> I sometimes wonder with your postings if you are underestimating your

> patients, underestimating the value of your care to your patients, or both. I

> suspect they would surprise you if you gave them a chance.

>

> Being only 37 years old, I will have paid a tremendous amount into Medicare by

> age 65, but I sincerely doubt that Medicare as we know it will be around when

> I am 65, so I consider my contributions not for myself, but for the current

> system. I do not anticipate benefitting from my Medicare contributions.

>

> Take care,

>

> , MD

> Durango, CO

>

> On Fri, 7 Apr 2006 08:13:06 -0400

> " Brock DO " wrote:

> > I guess you are not seeking new Medicare patients so my next question is

> > sort of irrelevant in your case, but isn't it possible that by being

> > non-participating that you are more than canceling out that little bit of

> > extra upfront income & ease by the large numbers of Medicare patients that

> > never even come to you because of that policy? In other words, you might

> > collect upfront on 200 pt's but lose 600 other Medicare pt's? As I've

> > mentioned before though, I guess that works (as does just about anything) if

> > your panel is small enough, and it sounds like you are running a very low

> > volume practice if you only have 200 Medicare pt's. Medicare billing is a

> > hassle but I'm certain I could not survive without taking that & staying

> > open to them. That is bar far my biggest payor. That still really

> > surprises me though that someone would pay into Medicare their entire

> > working life & then agree to pay out of pocket. I personally would

> > definitely not agree to that when I'm 65, no matter how good my doctor is,

> > but all of us approach things differently. All I can say is you must be a

> > great doctor to keep those 200 Medicare pt's that are willing to pay put of

> > pocket.

> >

> >

> >

> > Update and questions

> > > >>

> > > >>

> > > >>

> > > >> Hi All. Thought I'd continue the update chain and I've got a

> > > >> question or two for you.

> > > >>

> > > >> First, I'm one month in to my solo practice and have been mostly

> > > >> pleased. There have been some conflicts with my " roommates, " which

> > > >> include another doc (from whom I'm renting space) and our shared

> > > >> staff. Some of those conflicts are making me reconsider the rent

> > > >> part of the low-cost model and moving into my own space. While my

> > > >> expenses will increase, I will be better able to initiate office

> > > >> systems, EMRs, etc. -- which is more difficult as a solo practice

> > > >> moving into an established office that is resistant to change.

> > > >>

> > > >> My question is regarding practice size. What are some milestones

> > > >> you've had regarding number of patients? One month? One year?

> > > >> Have you been satisfied with your progress?

> > > >>

> > > >> Thanks.

> > > >>

> > > >> Brad

> > > >>

> > > >>

> > > >>

> > > >>

> > > >>

> > > >>

> > > >>

> > > >>

> > > >> YAHOO! GROUPS LINKS

> > > >>

> > > >> Visit your group " " on the web.

> > > >>

> > > >>

[Guest guest]

I have recently received a few Medicare transfer pt's from another somewhat

nearby doctor that decided to go " non participating. " They did not want any part

of that. I'm not sure just how many of his Medicare pt's are leaving, but I'm

sure a lot will. I'm sure close to 90% of my Medicare pt's would go elsewhere

if I became non participating.

>

>

> Date: 2006/04/07 Fri PM 07:09:20 EDT

> To:

> Subject: Re: Non participating Medicare Provider

>

> ,

> Medicare reimbursement is only going to decline as our administrative burdens

> go up (just can't wait to add the burden of P4P!!) as our costs, no matter how

> low overhead we are, go up. Medicare is not one of my better payers, and the

> patients are generally much higher maintenance by virtue of age. I consider

> this to be part of my indigent care, unfortunately. I am planning for the

> future by being a non-participating doctor.

>

> I currently have a patient panel of about 1000 patients, so Medicare

> constitutes only a small portion of my patient panel.

>

> I sometimes wonder with your postings if you are underestimating your

> patients, underestimating the value of your care to your patients, or both. I

> suspect they would surprise you if you gave them a chance.

>

> Being only 37 years old, I will have paid a tremendous amount into Medicare by

> age 65, but I sincerely doubt that Medicare as we know it will be around when

> I am 65, so I consider my contributions not for myself, but for the current

> system. I do not anticipate benefitting from my Medicare contributions.

>

> Take care,

>

> , MD

> Durango, CO

>

> On Fri, 7 Apr 2006 08:13:06 -0400

> " Brock DO " wrote:

> > I guess you are not seeking new Medicare patients so my next question is

> > sort of irrelevant in your case, but isn't it possible that by being

> > non-participating that you are more than canceling out that little bit of

> > extra upfront income & ease by the large numbers of Medicare patients that

> > never even come to you because of that policy? In other words, you might

> > collect upfront on 200 pt's but lose 600 other Medicare pt's? As I've

> > mentioned before though, I guess that works (as does just about anything) if

> > your panel is small enough, and it sounds like you are running a very low

> > volume practice if you only have 200 Medicare pt's. Medicare billing is a

> > hassle but I'm certain I could not survive without taking that & staying

> > open to them. That is bar far my biggest payor. That still really

> > surprises me though that someone would pay into Medicare their entire

> > working life & then agree to pay out of pocket. I personally would

> > definitely not agree to that when I'm 65, no matter how good my doctor is,

> > but all of us approach things differently. All I can say is you must be a

> > great doctor to keep those 200 Medicare pt's that are willing to pay put of

> > pocket.

> >

> >

> >

> > Update and questions

> > > >>

> > > >>

> > > >>

> > > >> Hi All. Thought I'd continue the update chain and I've got a

> > > >> question or two for you.

> > > >>

> > > >> First, I'm one month in to my solo practice and have been mostly

> > > >> pleased. There have been some conflicts with my " roommates, " which

> > > >> include another doc (from whom I'm renting space) and our shared

> > > >> staff. Some of those conflicts are making me reconsider the rent

> > > >> part of the low-cost model and moving into my own space. While my

> > > >> expenses will increase, I will be better able to initiate office

> > > >> systems, EMRs, etc. -- which is more difficult as a solo practice

> > > >> moving into an established office that is resistant to change.

> > > >>

> > > >> My question is regarding practice size. What are some milestones

> > > >> you've had regarding number of patients? One month? One year?

> > > >> Have you been satisfied with your progress?

> > > >>

> > > >> Thanks.

> > > >>

> > > >> Brad

> > > >>

> > > >>

> > > >>

> > > >>

> > > >>

> > > >>

> > > >>

> > > >>

> > > >> YAHOO! GROUPS LINKS

> > > >>

> > > >> Visit your group " " on the web.

> > > >>

> > > >>

[Guest guest]

-

I have come to the conclusion that the entity known as

" Brock " is actually a front for the insurance

and Medicare industry to scare people from

non-participating or opting-out (as I have) from the

Medicare system (or the insurance system in general).

I am 5 months into my brand new cash-only practice and

I fully expect to be closing to new patients by the

end of this year or early next.

You should consider opting-out completely - you can

charge what you want and you don't have to abide by

Medicare's medical necessity rules. Even if you are

non-participating you will still be limited to only

billing for services that are deemed " medically

necessary " as per Medicare.

--- MEGAN LEWIS wrote:

> ,

> Medicare reimbursement is only going to decline as

> our administrative burdens

> go up (just can't wait to add the burden of P4P!!)

> as our costs, no matter how

> low overhead we are, go up. Medicare is not one of

> my better payers, and the

> patients are generally much higher maintenance by

> virtue of age. I consider

> this to be part of my indigent care, unfortunately.

> I am planning for the

> future by being a non-participating doctor.

>

> I currently have a patient panel of about 1000

> patients, so Medicare

> constitutes only a small portion of my patient

> panel.

>

> I sometimes wonder with your postings if you are

> underestimating your

> patients, underestimating the value of your care to

> your patients, or both. I

> suspect they would surprise you if you gave them a

> chance.

>

> Being only 37 years old, I will have paid a

> tremendous amount into Medicare by

> age 65, but I sincerely doubt that Medicare as we

> know it will be around when

> I am 65, so I consider my contributions not for

> myself, but for the current

> system. I do not anticipate benefitting from my

> Medicare contributions.

>

> Take care,

>

> , MD

> Durango, CO

>

> On Fri, 7 Apr 2006 08:13:06 -0400

> " Brock DO " wrote:

> > I guess you are not seeking new Medicare

> patients so my next question is

> > sort of irrelevant in your case, but isn't it

> possible that by being

> > non-participating that you are more than canceling

> out that little bit of

> > extra upfront income & ease by the large numbers

> of Medicare patients that

> > never even come to you because of that policy? In

> other words, you might

> > collect upfront on 200 pt's but lose 600 other

> Medicare pt's? As I've

> > mentioned before though, I guess that works (as

> does just about anything) if

> > your panel is small enough, and it sounds like you

> are running a very low

> > volume practice if you only have 200 Medicare

> pt's. Medicare billing is a

> > hassle but I'm certain I could not survive without

> taking that & staying

> > open to them. That is bar far my biggest payor.

> That still really

> > surprises me though that someone would pay into

> Medicare their entire

> > working life & then agree to pay out of pocket. I

> personally would

> > definitely not agree to that when I'm 65, no

> matter how good my doctor is,

> > but all of us approach things differently. All I

> can say is you must be a

> > great doctor to keep those 200 Medicare pt's that

> are willing to pay put of

> > pocket.

> >

> >

> >

> > Re: WEBSITES

> > >

> > > My website is www.mountainviewmd.com. You are

> welcome to use any part of

> > it

> > >

> > > that strikes your fancy.

> > >

> > > , MD

> > > Durango, CO

> > >

> > >

> > > On Wed, 5 Apr 2006 11:08:52 -0700

> > > pamela wible wrote:

> > > > Kerry,

> > > >

> > > > My website is

> > > >

> > > > www.idealmedicalpractice.org

> > > >

> > > > I am not finished with it as I have photos to

> add of my " happy patients "

> > > > My goal with this website was to lay a

> foundation for the development

> > of

> > > >community solo medial clinics in neighborhoods

> around the country. It

> > is

> > > >less pt education on specific medical topics

> (which they get from me in

> > > >person) and more about how we can transform

> medical care in this country

> > > by

> > > >partnering with the citizens in our respective

> communities.

> > > >

> > > > It features how we accomplished this in Eugene

> - as a " test case " and

> > I

> > > >would like to see other doctors and communities

> feel

=== message truncated ===

__________________________________________________

[Guest guest]

-

I have come to the conclusion that the entity known as

" Brock " is actually a front for the insurance

and Medicare industry to scare people from

non-participating or opting-out (as I have) from the

Medicare system (or the insurance system in general).

I am 5 months into my brand new cash-only practice and

I fully expect to be closing to new patients by the

end of this year or early next.

You should consider opting-out completely - you can

charge what you want and you don't have to abide by

Medicare's medical necessity rules. Even if you are

non-participating you will still be limited to only

billing for services that are deemed " medically

necessary " as per Medicare.

--- MEGAN LEWIS wrote:

> ,

> Medicare reimbursement is only going to decline as

> our administrative burdens

> go up (just can't wait to add the burden of P4P!!)

> as our costs, no matter how

> low overhead we are, go up. Medicare is not one of

> my better payers, and the

> patients are generally much higher maintenance by

> virtue of age. I consider

> this to be part of my indigent care, unfortunately.

> I am planning for the

> future by being a non-participating doctor.

>

> I currently have a patient panel of about 1000

> patients, so Medicare

> constitutes only a small portion of my patient

> panel.

>

> I sometimes wonder with your postings if you are

> underestimating your

> patients, underestimating the value of your care to

> your patients, or both. I

> suspect they would surprise you if you gave them a

> chance.

>

> Being only 37 years old, I will have paid a

> tremendous amount into Medicare by

> age 65, but I sincerely doubt that Medicare as we

> know it will be around when

> I am 65, so I consider my contributions not for

> myself, but for the current

> system. I do not anticipate benefitting from my

> Medicare contributions.

>

> Take care,

>

> , MD

> Durango, CO

>

> On Fri, 7 Apr 2006 08:13:06 -0400

> " Brock DO " wrote:

> > I guess you are not seeking new Medicare

> patients so my next question is

> > sort of irrelevant in your case, but isn't it

> possible that by being

> > non-participating that you are more than canceling

> out that little bit of

> > extra upfront income & ease by the large numbers

> of Medicare patients that

> > never even come to you because of that policy? In

> other words, you might

> > collect upfront on 200 pt's but lose 600 other

> Medicare pt's? As I've

> > mentioned before though, I guess that works (as

> does just about anything) if

> > your panel is small enough, and it sounds like you

> are running a very low

> > volume practice if you only have 200 Medicare

> pt's. Medicare billing is a

> > hassle but I'm certain I could not survive without

> taking that & staying

> > open to them. That is bar far my biggest payor.

> That still really

> > surprises me though that someone would pay into

> Medicare their entire

> > working life & then agree to pay out of pocket. I

> personally would

> > definitely not agree to that when I'm 65, no

> matter how good my doctor is,

> > but all of us approach things differently. All I

> can say is you must be a

> > great doctor to keep those 200 Medicare pt's that

> are willing to pay put of

> > pocket.

> >

> >

> >

> > Re: WEBSITES

> > >

> > > My website is www.mountainviewmd.com. You are

> welcome to use any part of

> > it

> > >

> > > that strikes your fancy.

> > >

> > > , MD

> > > Durango, CO

> > >

> > >

> > > On Wed, 5 Apr 2006 11:08:52 -0700

> > > pamela wible wrote:

> > > > Kerry,

> > > >

> > > > My website is

> > > >

> > > > www.idealmedicalpractice.org

> > > >

> > > > I am not finished with it as I have photos to

> add of my " happy patients "

> > > > My goal with this website was to lay a

> foundation for the development

> > of

> > > >community solo medial clinics in neighborhoods

> around the country. It

> > is

> > > >less pt education on specific medical topics

> (which they get from me in

> > > >person) and more about how we can transform

> medical care in this country

> > > by

> > > >partnering with the citizens in our respective

> communities.

> > > >

> > > > It features how we accomplished this in Eugene

> - as a " test case " and

> > I

> > > >would like to see other doctors and communities

> feel

=== message truncated ===

__________________________________________________

[Guest guest]

Forgot to add that it is a bit of a hassle to opt-out

of Medicare - you have to plan ahead and send a letter

to your CMS carrier 30 days before the end of the

quarter prior to the date that you plan to begin to

practice as an opt-out physician - I didn't know this

and opened my practice in the 4th quarter of last year

(end of October), but I didn't file my paperwork by

the deadline (September 1st 2005, because the 4th

quarter startes on October 1st)), so I couldn't

officially opt out until January 1st of this year.

You also have to have EACH Medicare patient sign a

" Medicare Private Contract " - language for this

document is mandated by law - I can email you my

contract if you like.

Good Luck!

Rancho Mirage, CA

www.drchrisflores.com

--- MEGAN LEWIS wrote:

> ,

> Medicare reimbursement is only going to decline as

> our administrative burdens

> go up (just can't wait to add the burden of P4P!!)

> as our costs, no matter how

> low overhead we are, go up. Medicare is not one of

> my better payers, and the

> patients are generally much higher maintenance by

> virtue of age. I consider

> this to be part of my indigent care, unfortunately.

> I am planning for the

> future by being a non-participating doctor.

>

> I currently have a patient panel of about 1000

> patients, so Medicare

> constitutes only a small portion of my patient

> panel.

>

> I sometimes wonder with your postings if you are

> underestimating your

> patients, underestimating the value of your care to

> your patients, or both. I

> suspect they would surprise you if you gave them a

> chance.

>

> Being only 37 years old, I will have paid a

> tremendous amount into Medicare by

> age 65, but I sincerely doubt that Medicare as we

> know it will be around when

> I am 65, so I consider my contributions not for

> myself, but for the current

> system. I do not anticipate benefitting from my

> Medicare contributions.

>

> Take care,

>

> , MD

> Durango, CO

>

> On Fri, 7 Apr 2006 08:13:06 -0400

> " Brock DO " wrote:

> > I guess you are not seeking new Medicare

> patients so my next question is

> > sort of irrelevant in your case, but isn't it

> possible that by being

> > non-participating that you are more than canceling

> out that little bit of

> > extra upfront income & ease by the large numbers

> of Medicare patients that

> > never even come to you because of that policy? In

> other words, you might

> > collect upfront on 200 pt's but lose 600 other

> Medicare pt's? As I've

> > mentioned before though, I guess that works (as

> does just about anything) if

> > your panel is small enough, and it sounds like you

> are running a very low

> > volume practice if you only have 200 Medicare

> pt's. Medicare billing is a

> > hassle but I'm certain I could not survive without

> taking that & staying

> > open to them. That is bar far my biggest payor.

> That still really

> > surprises me though that someone would pay into

> Medicare their entire

> > working life & then agree to pay out of pocket. I

> personally would

> > definitely not agree to that when I'm 65, no

> matter how good my doctor is,

> > but all of us approach things differently. All I

> can say is you must be a

> > great doctor to keep those 200 Medicare pt's that

> are willing to pay put of

> > pocket.

> >

> >

> >

> > Re: WEBSITES

> > >

> > > My website is www.mountainviewmd.com. You are

> welcome to use any part of

> > it

> > >

> > > that strikes your fancy.

> > >

> > > , MD

> > > Durango, CO

> > >

> > >

> > > On Wed, 5 Apr 2006 11:08:52 -0700

> > > pamela wible wrote:

> > > > Kerry,

> > > >

> > > > My website is

> > > >

> > > > www.idealmedicalpractice.org

> > > >

> > > > I am not finished with it as I have photos to

> add of my " happy patients "

> > > > My goal with this website was to lay a

> foundation for the development

> > of

> > > >community solo medial clinics in neighborhoods

> around the country. It

> > is

> > > >less pt education on specific medical topics

> (which they get from me in

> > > >person) and more about how we can transform

> medical care in this country

> > > by

> > > >partnering with the citizens in our respective

> communities.

> > > >

> > > > It features how we accomplished this in Eugene

> - as a " test case " and

> > I

> > > >would like to see other doctors and communities

> feel

=== message truncated ===

__________________________________________________

[Guest guest]

Forgot to add that it is a bit of a hassle to opt-out

of Medicare - you have to plan ahead and send a letter

to your CMS carrier 30 days before the end of the

quarter prior to the date that you plan to begin to

practice as an opt-out physician - I didn't know this

and opened my practice in the 4th quarter of last year

(end of October), but I didn't file my paperwork by

the deadline (September 1st 2005, because the 4th

quarter startes on October 1st)), so I couldn't

officially opt out until January 1st of this year.

You also have to have EACH Medicare patient sign a

" Medicare Private Contract " - language for this

document is mandated by law - I can email you my

contract if you like.

Good Luck!

Rancho Mirage, CA

www.drchrisflores.com

--- MEGAN LEWIS wrote:

> ,

> Medicare reimbursement is only going to decline as

> our administrative burdens

> go up (just can't wait to add the burden of P4P!!)

> as our costs, no matter how

> low overhead we are, go up. Medicare is not one of

> my better payers, and the

> patients are generally much higher maintenance by

> virtue of age. I consider

> this to be part of my indigent care, unfortunately.

> I am planning for the

> future by being a non-participating doctor.

>

> I currently have a patient panel of about 1000

> patients, so Medicare

> constitutes only a small portion of my patient

> panel.

>

> I sometimes wonder with your postings if you are

> underestimating your

> patients, underestimating the value of your care to

> your patients, or both. I

> suspect they would surprise you if you gave them a

> chance.

>

> Being only 37 years old, I will have paid a

> tremendous amount into Medicare by

> age 65, but I sincerely doubt that Medicare as we

> know it will be around when

> I am 65, so I consider my contributions not for

> myself, but for the current

> system. I do not anticipate benefitting from my

> Medicare contributions.

>

> Take care,

>

> , MD

> Durango, CO

>

> On Fri, 7 Apr 2006 08:13:06 -0400

> " Brock DO " wrote:

> > I guess you are not seeking new Medicare

> patients so my next question is

> > sort of irrelevant in your case, but isn't it

> possible that by being

> > non-participating that you are more than canceling

> out that little bit of

> > extra upfront income & ease by the large numbers

> of Medicare patients that

> > never even come to you because of that policy? In

> other words, you might

> > collect upfront on 200 pt's but lose 600 other

> Medicare pt's? As I've

> > mentioned before though, I guess that works (as

> does just about anything) if

> > your panel is small enough, and it sounds like you

> are running a very low

> > volume practice if you only have 200 Medicare

> pt's. Medicare billing is a

> > hassle but I'm certain I could not survive without

> taking that & staying

> > open to them. That is bar far my biggest payor.

> That still really

> > surprises me though that someone would pay into

> Medicare their entire

> > working life & then agree to pay out of pocket. I

> personally would

> > definitely not agree to that when I'm 65, no

> matter how good my doctor is,

> > but all of us approach things differently. All I

> can say is you must be a

> > great doctor to keep those 200 Medicare pt's that

> are willing to pay put of

> > pocket.

> >

> >

> >

> > Re: WEBSITES

> > >

> > > My website is www.mountainviewmd.com. You are

> welcome to use any part of

> > it

> > >

> > > that strikes your fancy.

> > >

> > > , MD

> > > Durango, CO

> > >

> > >

> > > On Wed, 5 Apr 2006 11:08:52 -0700

> > > pamela wible wrote:

> > > > Kerry,

> > > >

> > > > My website is

> > > >

> > > > www.idealmedicalpractice.org

> > > >

> > > > I am not finished with it as I have photos to

> add of my " happy patients "

> > > > My goal with this website was to lay a

> foundation for the development

> > of

> > > >community solo medial clinics in neighborhoods

> around the country. It

> > is

> > > >less pt education on specific medical topics

> (which they get from me in

> > > >person) and more about how we can transform

> medical care in this country

> > > by

> > > >partnering with the citizens in our respective

> communities.

> > > >

> > > > It features how we accomplished this in Eugene

> - as a " test case " and

> > I

> > > >would like to see other doctors and communities

> feel

=== message truncated ===

__________________________________________________

[Guest guest]

Dear

Forgive my

ignorance, but what is a CMS carrier? Also, if I opt out of

medicare, will labs, etc. that I order be covered?

Where can

I find the rates that Medicare reimburses in my area for various

codes?

On that

same vein, if I do cash practice & some HMO patients chose to pay to

see me, will things I order be covered, or will I have to get their PCP

of record to do that? I imagine it depends on the plan, but I was

wondering if anyone had experience with that.

Thanks,

Sharon

(Currently

in Siena, Italy; practice starting in Irvine, CA late summer)

At 06:51 AM 4/8/2006, you wrote:

Forgot to add that it

is a bit of a hassle to opt-out

of Medicare - you have to plan ahead and send a letter

to your CMS carrier 30 days before the end of the

quarter prior to the date that you plan to begin to

practice as an opt-out physician - I didn't know this

and opened my practice in the 4th quarter of last year

(end of October), but I didn't file my paperwork by

the deadline (September 1st 2005, because the 4th

quarter startes on October 1st)), so I couldn't

officially opt out until January 1st of this year.

You also have to have EACH Medicare patient sign a

" Medicare Private Contract " - language for this

document is mandated by law - I can email you my

contract if you like.

Good Luck!

Rancho Mirage, CA

www.drchrisflores.com

--- MEGAN LEWIS wrote:

> ,

> Medicare reimbursement is only going to decline as

> our administrative burdens

> go up (just can't wait to add the burden of P4P!!)

> as our costs, no matter how

> low overhead we are, go up. Medicare is not one of

> my better payers, and the

> patients are generally much higher maintenance by

> virtue of age. I consider

> this to be part of my indigent care, unfortunately.

> I am planning for the

> future by being a non-participating doctor.

>

> I currently have a patient panel of about 1000

> patients, so Medicare

> constitutes only a small portion of my patient

> panel.

>

> I sometimes wonder with your postings if you are

> underestimating your

> patients, underestimating the value of your care to

> your patients, or both. I

> suspect they would surprise you if you gave them a

> chance.

>

> Being only 37 years old, I will have paid a

> tremendous amount into Medicare by

> age 65, but I sincerely doubt that Medicare as we

> know it will be around when

> I am 65, so I consider my contributions not for

> myself, but for the current

> system. I do not anticipate benefitting from my

> Medicare contributions.

>

> Take care,

>

> , MD

> Durango, CO

>

> On Fri, 7 Apr 2006 08:13:06 -0400

> " Brock DO "

wrote:

> > I guess you are not seeking new Medicare

> patients so my next question is

> > sort of irrelevant in your case, but isn't it

> possible that by being

> > non-participating that you are more than canceling

> out that little bit of

> > extra upfront income & ease by the large numbers

> of Medicare patients that

> > never even come to you because of that policy? In

> other words, you might

> > collect upfront on 200 pt's but lose 600 other

> Medicare pt's? As I've

> > mentioned before though, I guess that works (as

> does just about anything) if

> > your panel is small enough, and it sounds like you

> are running a very low

> > volume practice if you only have 200 Medicare

> pt's. Medicare billing is a

> > hassle but I'm certain I could not survive without

> taking that & staying

> > open to them. That is bar far my biggest payor.

> That still really

> > surprises me though that someone would pay into

> Medicare their entire

> > working life & then agree to pay out of pocket.

I

> personally would

> > definitely not agree to that when I'm 65, no

> matter how good my doctor is,

> > but all of us approach things differently. All I

> can say is you must be a

> > great doctor to keep those 200 Medicare pt's that

> are willing to pay put of

> > pocket.

> >

> >

> >

> > Re: WEBSITES

> > >

> > > My website is

www.mountainviewmd.com. You are

> welcome to use any part of

> > it

> > >

> > > that strikes your fancy.

> > >

> > > , MD

> > > Durango, CO

> > >

> > >

> > > On Wed, 5 Apr 2006 11:08:52 -0700

> > > pamela wible

wrote:

> > > > Kerry,

> > > >

> > > > My website is

> > > >

> > > >

www.idealmedicalpractice.org

> > > >

> > > > I am not finished with it as I have photos to

> add of my " happy patients "

> > > > My goal with this website was to lay a

> foundation for the development

> > of

> > > >community solo medial clinics in neighborhoods

> around the country. It

> > is

> > > >less pt education on specific medical topics

> (which they get from me in

> > > >person) and more about how we can transform

> medical care in this country

> > > by

> > > >partnering with the citizens in our

respective

> communities.

> > > >

> > > > It features how we accomplished this in Eugene

> - as a " test case " and

> > I

> > > >would like to see other doctors and communities

> feel

=== message truncated ===

__________________________________________________

[Guest guest]

Yes, but key question: where is your practice located? That is the reason this

works for you. I know I say it a lot, but some things will only work in a very

specific location or niche market. There are so many variables: local

malpractice climate, payor mix, average age of patients, saturation of doctors,

" trendiness " of area vs more " simple folks " , etc.

>

>

> Date: 2006/04/08 Sat AM 12:38:04 EDT

> To:

> Subject: Re: Non participating Medicare Provider

>

> -

>

> I have come to the conclusion that the entity known as

> " Brock " is actually a front for the insurance

> and Medicare industry to scare people from

> non-participating or opting-out (as I have) from the

> Medicare system (or the insurance system in general).

> I am 5 months into my brand new cash-only practice and

> I fully expect to be closing to new patients by the

> end of this year or early next.

>

> You should consider opting-out completely - you can

> charge what you want and you don't have to abide by

> Medicare's medical necessity rules. Even if you are

> non-participating you will still be limited to only

> billing for services that are deemed " medically

> necessary " as per Medicare.

>

> --- MEGAN LEWIS wrote:

>

> > ,

> > Medicare reimbursement is only going to decline as

> > our administrative burdens

> > go up (just can't wait to add the burden of P4P!!)

> > as our costs, no matter how

> > low overhead we are, go up. Medicare is not one of

> > my better payers, and the

> > patients are generally much higher maintenance by

> > virtue of age. I consider

> > this to be part of my indigent care, unfortunately.

> > I am planning for the

> > future by being a non-participating doctor.

> >

> > I currently have a patient panel of about 1000

> > patients, so Medicare

> > constitutes only a small portion of my patient

> > panel.

> >

> > I sometimes wonder with your postings if you are

> > underestimating your

> > patients, underestimating the value of your care to

> > your patients, or both. I

> > suspect they would surprise you if you gave them a

> > chance.

> >

> > Being only 37 years old, I will have paid a

> > tremendous amount into Medicare by

> > age 65, but I sincerely doubt that Medicare as we

> > know it will be around when

> > I am 65, so I consider my contributions not for

> > myself, but for the current

> > system. I do not anticipate benefitting from my

> > Medicare contributions.

> >

> > Take care,

> >

> > , MD

> > Durango, CO

> >

> > On Fri, 7 Apr 2006 08:13:06 -0400

> > " Brock DO " wrote:

> > > I guess you are not seeking new Medicare

> > patients so my next question is

> > > sort of irrelevant in your case, but isn't it

> > possible that by being

> > > non-participating that you are more than canceling

> > out that little bit of

> > > extra upfront income & ease by the large numbers

> > of Medicare patients that

> > > never even come to you because of that policy? In

> > other words, you might

> > > collect upfront on 200 pt's but lose 600 other

> > Medicare pt's? As I've

> > > mentioned before though, I guess that works (as

> > does just about anything) if

> > > your panel is small enough, and it sounds like you

> > are running a very low

> > > volume practice if you only have 200 Medicare

> > pt's. Medicare billing is a

> > > hassle but I'm certain I could not survive without

> > taking that & staying

> > > open to them. That is bar far my biggest payor.

> > That still really

> > > surprises me though that someone would pay into

> > Medicare their entire

> > > working life & then agree to pay out of pocket. I

> > personally would

> > > definitely not agree to that when I'm 65, no

> > matter how good my doctor is,

> > > but all of us approach things differently. All I

> > can say is you must be a

> > > great doctor to keep those 200 Medicare pt's that

> > are willing to pay put of

> > > pocket.

> > >

> > >

> > >

> > > Re: WEBSITES

> > > >

> > > > My website is www.mountainviewmd.com. You are

> > welcome to use any part of

> > > it

> > > >

> > > > that strikes your fancy.

> > > >

> > > > , MD

> > > > Durango, CO

> > > >

> > > >

> > > > On Wed, 5 Apr 2006 11:08:52 -0700

> > > > pamela wible wrote:

> > > > > Kerry,

> > > > >

> > > > > My website is

> > > > >

> > > > > www.idealmedicalpractice.org

> > > > >

> > > > > I am not finished with it as I have photos to

> > add of my " happy patients "

> > > > > My goal with this website was to lay a

> > foundation for the development

> > > of

> > > > >community solo medial clinics in neighborhoods

> > around the country. It

> > > is

> > > > >less pt education on specific medical topics

> > (which they get from me in

> > > > >person) and more about how we can transform

> > medical care in this country

> > > > by

> > > > >partnering with the citizens in our respective

> > communities.

> > > > >

> > > > > It features how we accomplished this in Eugene

> > - as a " test case " and

> > > I

> > > > >would like to see other doctors and communities

> > feel

> === message truncated ===

>

>

> __________________________________________________

>

[Guest guest]

Can you please send me your version of the 'Medicare Private Contract'? I'm

@ michelle.eads@.... Thanks

A. Eads, M.D.

Pinnacle Family Medicine, PLLC

phone fax

P.O. Box 7275

Woodland Park, CO 80863

Re: WEBSITES

> > >

> > > My website is www.mountainviewmd.com. You are

> welcome to use any part of

> > it

> > >

> > > that strikes your fancy.

> > >

> > > , MD

> > > Durango, CO

> > >

> > >

> > > On Wed, 5 Apr 2006 11:08:52 -0700

> > > pamela wible wrote:

> > > > Kerry,

> > > >

> > > > My website is

> > > >

> > > > www.idealmedicalpractice.org

> > > >

> > > > I am not finished with it as I have photos to

> add of my " happy patients "

> > > > My goal with this website was to lay a

> foundation for the development

> > of

> > > >community solo medial clinics in neighborhoods

> around the country. It

> > is

> > > >less pt education on specific medical topics

> (which they get from me in

> > > >person) and more about how we can transform

> medical care in this country

> > > by

> > > >partnering with the citizens in our respective

> communities.

> > > >

> > > > It features how we accomplished this in Eugene

> - as a " test case " and

> > I

> > > >would like to see other doctors and communities

> feel

=== message truncated ===

__________________________________________________

[Guest guest]

Sharon,

I have a handful of medicare pts that see

me (I’ve opted out). The things I order are covered (labs, imaging,

etc), but do need to have them sign an ABN (advanced beneficiary notice) at

times. For HMOs that I’m out of network for, the only issue is with

those that require a referral – that must be done by their ‘official’

(ie, on their card) PCP. Labs and imaging has been covered as long as it

was done in a network facility.

A. Eads, M.D.

Pinnacle Family Medicine, PLLC

phone fax

P.O.

Box 7275

Woodland

Park, CO 80863

From:

[mailto: ] On

Behalf Of Sharon McCoy

Sent: Saturday, April 08, 2006

12:50 AM

To:

Subject: Re:

Non participating Medicare Provider

Dear

Forgive

my ignorance, but what is a CMS carrier? Also, if I opt out of medicare,

will labs, etc. that I order be covered?

Where

can I find the rates that Medicare reimburses in my area for various codes?

On

that same vein, if I do cash practice & some HMO patients chose to pay to

see me, will things I order be covered, or will I have to get their PCP of

record to do that? I imagine it depends on the plan, but I was wondering

if anyone had experience with that.

Thanks,

Sharon

(Currently

in Siena, Italy;

practice starting in Irvine,

CA late summer)

At 06:51 AM 4/8/2006, you wrote:

Forgot to add that it is a

bit of a hassle to opt-out

of Medicare - you have to plan ahead and send a

letter

to your CMS carrier 30 days before the end of the

quarter prior to the date that you plan to begin

to

practice as an opt-out physician - I didn't know

this

and opened my practice in the 4th quarter of last

year

(end of October), but I didn't file my paperwork

by

the deadline (September 1st 2005, because the 4th

quarter startes on October 1st)), so I couldn't

officially opt out until January 1st of this year.

You also have to have EACH Medicare patient sign a

" Medicare Private Contract " - language

for this

document is mandated by law - I can email you my

contract if you like.

Good Luck!

Rancho Mirage, CA

www.drchrisflores.com

--- MEGAN LEWIS

wrote:

> ,

> Medicare reimbursement is only going to

decline as

> our administrative burdens

> go up (just can't wait to add the burden of

P4P!!)

> as our costs, no matter how

> low overhead we are, go up. Medicare is not

one of

> my better payers, and the

> patients are generally much higher

maintenance by

> virtue of age. I consider

> this to be part of my indigent care,

unfortunately.

> I am planning for the

> future by being a non-participating doctor.

>

> I currently have a patient panel of about

1000

> patients, so Medicare

> constitutes only a small portion of my

patient

> panel.

>

> I sometimes wonder with your postings if you

are

> underestimating your

> patients, underestimating the value of your

care to

> your patients, or both. I

> suspect they would surprise you if you gave

them a

> chance.

>

> Being only 37 years old, I will have paid a

> tremendous amount into Medicare by

> age 65, but I sincerely doubt that Medicare

as we

> know it will be around when

> I am 65, so I consider my contributions not

for

> myself, but for the current

> system. I do not anticipate benefitting

from my

> Medicare contributions.

>

> Take care,

>

> , MD

> Durango,

CO

>

> On Fri, 7 Apr 2006 08:13:06 -0400

> " Brock DO "

wrote:

> > I guess you are not seeking

new Medicare

> patients so my next question is

> > sort of irrelevant in your case, but

isn't it

> possible that by being

> > non-participating that you are more than

canceling

> out that little bit of

> > extra upfront income & ease by the

large numbers

> of Medicare patients that

> > never even come to you because of that

policy? In

> other words, you might

> > collect upfront on 200 pt's but lose 600

other

> Medicare pt's? As I've

> > mentioned before though, I guess that

works (as

> does just about anything) if

> > your panel is small enough, and it

sounds like you

> are running a very low

> > volume practice if you only have 200

Medicare

> pt's. Medicare billing is a

> > hassle but I'm certain I could not survive

without

> taking that & staying

> > open to them. That is bar far my

biggest payor.

> That still really

> > surprises me though that someone would

pay into

> Medicare their entire

> > working life & then agree to pay out

of pocket. I

> personally would

> > definitely not agree to that when I'm

65, no

> matter how good my doctor is,

> > but all of us approach things

differently. All I

> can say is you must be a

> > great doctor to keep those 200 Medicare

pt's that

> are willing to pay put of

> > pocket.

> >

> >

> >

> > Re:

WEBSITES

> > >

> > > My website is www.mountainviewmd.com.

You are

> welcome to use any part of

> > it

> > >

> > > that strikes your fancy.

> > >

> > > , MD

> > > Durango, CO

> > >

> > >

> > > On Wed, 5 Apr 2006 11:08:52 -0700

> > > pamela wible

wrote:

> > > > Kerry,

> > > >

> > > > My website is

> > > >

> > > > www.idealmedicalpractice.org

> > > >

> > > > I am not finished with it as I

have photos to

> add of my " happy patients "

> > > > My goal with this website was

to lay a

> foundation for the development

> > of

> > > >community solo medial clinics

in neighborhoods

> around the country. It

> > is

> > > >less pt education on specific

medical topics

> (which they get from me in

> > > >person) and more about how we

can transform

> medical care in this country

> > > by

> > > >partnering with the citizens in

our respective

> communities.

> > > >

> > > > It features how we

accomplished this in Eugene

> - as a " test case " and

> > I

> > > >would like to see other doctors

and communities

> feel

=== message truncated ===

__________________________________________________

[Guest guest]

Sharon,

I have a handful of medicare pts that see

me (I’ve opted out). The things I order are covered (labs, imaging,

etc), but do need to have them sign an ABN (advanced beneficiary notice) at

times. For HMOs that I’m out of network for, the only issue is with

those that require a referral – that must be done by their ‘official’

(ie, on their card) PCP. Labs and imaging has been covered as long as it

was done in a network facility.

A. Eads, M.D.

Pinnacle Family Medicine, PLLC

phone fax

P.O.

Box 7275

Woodland

Park, CO 80863

From:

[mailto: ] On

Behalf Of Sharon McCoy

Sent: Saturday, April 08, 2006

12:50 AM

To:

Subject: Re:

Non participating Medicare Provider

Dear

Forgive

my ignorance, but what is a CMS carrier? Also, if I opt out of medicare,

will labs, etc. that I order be covered?

Where

can I find the rates that Medicare reimburses in my area for various codes?

On

that same vein, if I do cash practice & some HMO patients chose to pay to

see me, will things I order be covered, or will I have to get their PCP of

record to do that? I imagine it depends on the plan, but I was wondering

if anyone had experience with that.

Thanks,

Sharon

(Currently

in Siena, Italy;

practice starting in Irvine,

CA late summer)

At 06:51 AM 4/8/2006, you wrote:

Forgot to add that it is a

bit of a hassle to opt-out

of Medicare - you have to plan ahead and send a

letter

to your CMS carrier 30 days before the end of the

quarter prior to the date that you plan to begin

to

practice as an opt-out physician - I didn't know

this

and opened my practice in the 4th quarter of last

year

(end of October), but I didn't file my paperwork

by

the deadline (September 1st 2005, because the 4th

quarter startes on October 1st)), so I couldn't

officially opt out until January 1st of this year.

You also have to have EACH Medicare patient sign a

" Medicare Private Contract " - language

for this

document is mandated by law - I can email you my

contract if you like.

Good Luck!

Rancho Mirage, CA

www.drchrisflores.com

--- MEGAN LEWIS

wrote:

> ,

> Medicare reimbursement is only going to

decline as

> our administrative burdens

> go up (just can't wait to add the burden of

P4P!!)

> as our costs, no matter how

> low overhead we are, go up. Medicare is not

one of

> my better payers, and the

> patients are generally much higher

maintenance by

> virtue of age. I consider

> this to be part of my indigent care,

unfortunately.

> I am planning for the

> future by being a non-participating doctor.

>

> I currently have a patient panel of about

1000

> patients, so Medicare

> constitutes only a small portion of my

patient

> panel.

>

> I sometimes wonder with your postings if you

are

> underestimating your

> patients, underestimating the value of your

care to

> your patients, or both. I

> suspect they would surprise you if you gave

them a

> chance.

>

> Being only 37 years old, I will have paid a

> tremendous amount into Medicare by

> age 65, but I sincerely doubt that Medicare

as we

> know it will be around when

> I am 65, so I consider my contributions not

for

> myself, but for the current

> system. I do not anticipate benefitting

from my

> Medicare contributions.

>

> Take care,

>

> , MD

> Durango,

CO

>

> On Fri, 7 Apr 2006 08:13:06 -0400

> " Brock DO "

wrote:

> > I guess you are not seeking

new Medicare

> patients so my next question is

> > sort of irrelevant in your case, but

isn't it

> possible that by being

> > non-participating that you are more than

canceling

> out that little bit of

> > extra upfront income & ease by the

large numbers

> of Medicare patients that

> > never even come to you because of that

policy? In

> other words, you might

> > collect upfront on 200 pt's but lose 600

other

> Medicare pt's? As I've

> > mentioned before though, I guess that

works (as

> does just about anything) if

> > your panel is small enough, and it

sounds like you

> are running a very low

> > volume practice if you only have 200

Medicare

> pt's. Medicare billing is a

> > hassle but I'm certain I could not survive

without

> taking that & staying

> > open to them. That is bar far my

biggest payor.

> That still really

> > surprises me though that someone would

pay into

> Medicare their entire

> > working life & then agree to pay out

of pocket. I

> personally would

> > definitely not agree to that when I'm

65, no

> matter how good my doctor is,

> > but all of us approach things

differently. All I

> can say is you must be a

> > great doctor to keep those 200 Medicare

pt's that

> are willing to pay put of

> > pocket.

> >

> >

> >

> > Re:

WEBSITES

> > >

> > > My website is www.mountainviewmd.com.

You are

> welcome to use any part of

> > it

> > >

> > > that strikes your fancy.

> > >

> > > , MD

> > > Durango, CO

> > >

> > >

> > > On Wed, 5 Apr 2006 11:08:52 -0700

> > > pamela wible

wrote:

> > > > Kerry,

> > > >

> > > > My website is

> > > >

> > > > www.idealmedicalpractice.org

> > > >

> > > > I am not finished with it as I

have photos to

> add of my " happy patients "

> > > > My goal with this website was

to lay a

> foundation for the development

> > of

> > > >community solo medial clinics

in neighborhoods

> around the country. It

> > is

> > > >less pt education on specific

medical topics

> (which they get from me in

> > > >person) and more about how we

can transform

> medical care in this country

> > > by

> > > >partnering with the citizens in

our respective

> communities.

> > > >

> > > > It features how we

accomplished this in Eugene

> - as a " test case " and

> > I

> > > >would like to see other doctors

and communities

> feel

=== message truncated ===

__________________________________________________

[Guest guest]

Hi Sharon - I think some of this has been answered in

other posts but here is a link for National Heritage

Insurance Company that is the carrier for California.

It may be of interest to other folks throughout the

country because you can download a fee schedule and

compare what you get to what Medicare pays in

California.

http://www.medicarenhic.com/cal_prov/fee_sched.shtml

If you can't link directly you may have to copy and

paste into your browser window. Basically, CMS

(Center for Medicare and Medicaide Services) is the

branch of government which pays out all Medicare

claims - however, they use regional " carriers " -

intermediaries - to actually " process " (in my

experience this means lose, delay, deny, and pay very

little) all physician claims from their region. I

believe Irvine is in the Southern California Region

(that sounds obvious but I am in Riverside County

which sure looks like SoCal on a map, but I am in the

Northern California region).

As others have said, labs, tests, etc. are still

covered even if you opt-out, assuming that they meet

medical necessity requirements (e.g. if you order a

HbA1C you better write ICD9 250.00 or related code,

etc.). I do not currently give any Advance

Beneficiary Notices (ABNs) because I am opted-out

completely - however, I am looking into this issue (it

can be confusing what the legal requirements are if

you are opted-out vs. non-participating).

As far as HMO patients go, I usually have to call

their " PCP " office to order tests for me -

interestingly, these offices are usually more than

happy to do so (I typically don't speak to the busy

clinician, usually it's the MA) because I've done the

leg work and saved them an office visit (they're still

getting their per-member-per-month so they don't

care). I fax them a copy of my note and clinical

reasoning. I have had to talk with the PCP when

ordering more expensive tests (e.g. PET scan for

possible cancer). Also, I tend to prescribe

cost-effective meds (Amox for otitis, Bactrim for

UTI), so the copay is more expensive than the

medication anyway.

Hope this helps.

CF

--- Sharon McCoy wrote:

> Dear

> Forgive my ignorance, but what is a CMS

> carrier? Also, if I

> opt out of medicare, will labs, etc. that I order be

> covered?

> Where can I find the rates that Medicare

> reimburses in my

> area for various codes?

> On that same vein, if I do cash practice &

> some HMO patients

> chose to pay to see me, will things I order be

> covered, or will I

> have to get their PCP of record to do that? I

> imagine it depends on

> the plan, but I was wondering if anyone had

> experience with that.

> Thanks,

> Sharon

> (Currently in Siena, Italy; practice

> starting in Irvine, CA

> late summer)

>

>

>

> At 06:51 AM 4/8/2006, you wrote:

> >Forgot to add that it is a bit of a hassle to

> opt-out

> >of Medicare - you have to plan ahead and send a

> letter

> >to your CMS carrier 30 days before the end of the

> >quarter prior to the date that you plan to begin to

> >practice as an opt-out physician - I didn't know

> this

> >and opened my practice in the 4th quarter of last

> year

> >(end of October), but I didn't file my paperwork by

> >the deadline (September 1st 2005, because the 4th

> >quarter startes on October 1st)), so I couldn't

> >officially opt out until January 1st of this year.

> >You also have to have EACH Medicare patient sign a

> > " Medicare Private Contract " - language for this

> >document is mandated by law - I can email you my

> >contract if you like.

> >

> >Good Luck!

> >

> >

> >Rancho Mirage, CA

> >www.drchrisflores.com

> >

> >--- MEGAN LEWIS wrote:

> >

> > > ,

> > > Medicare reimbursement is only going to decline

> as

> > > our administrative burdens

> > > go up (just can't wait to add the burden of

> P4P!!)

> > > as our costs, no matter how

> > > low overhead we are, go up. Medicare is not one

> of

> > > my better payers, and the

> > > patients are generally much higher maintenance

> by

> > > virtue of age. I consider

> > > this to be part of my indigent care,

> unfortunately.

> > > I am planning for the

> > > future by being a non-participating doctor.

> > >

> > > I currently have a patient panel of about 1000

> > > patients, so Medicare

> > > constitutes only a small portion of my patient

> > > panel.

> > >

> > > I sometimes wonder with your postings if you are

> > > underestimating your

> > > patients, underestimating the value of your care

> to

> > > your patients, or both. I

> > > suspect they would surprise you if you gave them

> a

> > > chance.

> > >

> > > Being only 37 years old, I will have paid a

> > > tremendous amount into Medicare by

> > > age 65, but I sincerely doubt that Medicare as

> we

> > > know it will be around when

> > > I am 65, so I consider my contributions not for

> > > myself, but for the current

> > > system. I do not anticipate benefitting from my

> > > Medicare contributions.

> > >

> > > Take care,

> > >

> > > , MD

> > > Durango, CO

> > >

> > > On Fri, 7 Apr 2006 08:13:06 -0400

> > > " Brock DO " wrote:

> > > > I guess you are not seeking new Medicare

> > > patients so my next question is

> > > > sort of irrelevant in your case, but isn't it

> > > possible that by being

> > > > non-participating that you are more than

> canceling

> > > out that little bit of

> > > > extra upfront income & ease by the large

> numbers

> > > of Medicare patients that

> > > > never even come to you because of that policy?

> In

> > > other words, you might

> > > > collect upfront on 200 pt's but lose 600 other

> > > Medicare pt's? As I've

> > > > mentioned before though, I guess that works

> (as

> > > does just about anything) if

> > > > your panel is small enough, and it sounds like

> you

> > > are running a very low

> > > > volume practice if you only have 200 Medicare

> > > pt's. Medicare billing is a

> > > > hassle but I'm certain I could not survive

> without

> > > taking that & staying

> > > > open to them. That is bar far my biggest

> payor.

> > > That still really

> > > > surprises me though that someone would pay

> into

> > > Medicare their entire

> > > > working life & then agree to pay out of

> pocket. I

> > > personally would

> > > > definitely not agree to that when I'm 65, no

> > > matter how good my doctor is,

> > > > but all of us approach things differently.

> All I

> > > can say is you must be a

> > > > great doctor to keep those 200 Medicare pt's

> that

> > > are willing to pay put of

> > > > pocket.

> > > >

> > > >

> > > >

> > > > Non

> participating

> > > Medicare Provider

> > > >

> > > > ,

> > > > As a non-participating provider, I am able to

> bill

> > > 115% of 95% of the

> > > > Medicare

> > > > fee schedule, which brings in a little more

> cash

> > > than accepting assignment.

> > > > ALL of my Medicare patients pay up front, or

> they

> > > go somewhere else. It

> > > > really helps my cash flow, as I see that money

> > > immediately (how

> > > > refreshing!).

> > > >

> > > > The Mayo Clinic in sdale, Arizona has

> become

> > > a " nonparticipating "

> > > > hospital, so the idea is growing and patients

> in

> > > this part of the country

> > > > are

> > > > going to see more and more " nonparticipating "

> > > providers.

> > > >

> > > > My Medicare patients do not submit the HCFA

> forms

> > > (the rules say the

> > > > provider

> > > > has to). We submit the HCFA 1500 form usually

> > > within 24 hours of the visit

> > > > and Medicare cuts them a check that they

> receive

> > > within 2-3 weeks of their

> > > > visit. The EOB tells them how much money they

> > > would have saved by seeing a

> > > > provider that accepts assignment, but none of

> them

> > > seem to mind.

> > > >

> > > > I currently have right at 200 Medicare

> patients

>

=== message truncated ===

__________________________________________________

[Guest guest]

Thanks Chris. That is very helpful. (I'll try to

be better at looking up stuff on the old posts first....)

Thanks also to all for the info on professionals you hired, I'm still

digesting it....

Sharon

______________________

Sharon McCoy , M.D.