If Doctors Bolt Then Is Med Supp Better

[MedSuppPro]

The current Medicare physician payment system places seniors' access to care at risk year after year by tying payments to the gross domestic product. It is keeping payment rates about the same as they were in 2001. The 2007 Medicare Trustees report predicts total cuts of about 40 percent by 2016.

It ultimately effects access to care for military families, as payment rates in the TRICARE program are tied to Medicare rates. This issue has implications for MA plans.

The Medicare physician payment formula varies by location. Some of us older agents can recall when excess charges where very common. Most of us know that history repeats itself. Another way to look at it is cost shifting.

[FONT=&quot]Maybe we should bring back the United American MMX+ plan! [/FONT]

 

[Frank Stastny]

Welll yes,,,plan F or G would pick up excess, just remember excess has a cap of 115% of medicare allowable.

....what I don't get is why the doctor doesn't refuse assignment and ask for full price. then the client would pay the difference between dr's bill and Medicare 80% payment, and get reimbursed partly or wholly from ins co.

Some doctors want the whole bill paid up front, and just assist patient in filing claims.

I'm not sure I understand the above statement. If a doctor refuses to accept assignment then the doctor is entitled to charge 15% more than Medicare approved. That part I know. However, the doctor cannot refuse to accept assignment and then charge the patient the full cost the doctor would expect to receive from a non-Medicare patient. That is what doctors were allowed to do before the changes in Medicare that took place around 1994.

Accepting assignment simply means the doctor agrees to accept the amount Medicare approves as full payment. Not accepting assignment means the doctor can charge 15% more.

Doctors who want the whole bill paid up front from a patient on Medicare must file the claim with Medicare, not assist the patient in filing the claim. I don't believe that a patient can file a claim with Medicare. When the doctor receives payment from Medicare then the doctor is legally obligated to reimburse the patient for the money they paid.

Before automatic claims filing, early 90's, patients had to file their claims with the insurance company but the doctor has always had to file the claim with Medicare.

I do not believe it is legal for a doctor to see a Medicare patient and then not file the claim with Medicare.

 

[Frank Stastny]

Plus, I am tryng to find a Medicare doctor for my mother. Surprise...not that easy. So here we have an aging population with a shrinking doctor base. And this has happened to my MA(pffs) clients also....where their provider abruptly quit taking MA plans. What part did Medicare play in that decision, I don't know. Other agents posted the same experience this past fall/winter. I remember seeing your posts so I'm sure you read some of that too.

Does your mother have a Supplement or a PFFS plan? I would hope you put her with a Supplement.

Medicare doesn't play any role in the decision for a doctor to opt out of a PFFS plan or any MA plan other than having developed a crappy plan. That is entirely the doctors choice. The government still hasn't taken that decision away from the doctors, at least not yet.

I believe that we are going to see more and more doctors opting out of the PFFS plans, especially if that doctors practice is not in a large metro area. PFFS plans suck in rural America.

 

[Frank Stastny]

I only knew of one Dr in the KC metro that did not accept Medicare assignment. I am sure there are more, but they are few and far between.

If you do run into the situation, then I would advise that you call the Dr's office while at the appointment to see how they would handle billing.

The doctor accepting assignment or not accepting assignment has nothing to do with billing. From the patients perspective the billing is handled by the doctors office regardless. The patient never enters into the equation.

 

[Frank Stastny]

If doctors do not accept assignment they are not making an additional 15% more.

If they do not accept assignment Medicare reduces the amount they would usually approve by 5%. The doctor can then add 15% to the reduced amount. So, the doctor is really getting around 9.25% more instead of 15%.

Also, both the insurance company and Medicare send the checks to the doctor's patient. Now the doctor has to spend additional money sending out statements or in some cases, not getting paid at all.

If they do accept assignment they get their checks directly from Medicare and the Supplement company. No billing necessary. That is the main reason that there was such a large percentage of doctors who began accepting assignment when that change in the law took place.

I doubt that we are going to see huge numbers of doctors who now accept assignment begin not accepting assignment.

 

[GreenSky]

If doctors do not accept assignment they are not making an additional 15% more.

If they do not accept assignment Medicare reduces the amount they would usually approve by 5%. The doctor can then add 15% to the reduced amount. So, the doctor is really getting around 9.25% more instead of 15%.

Frank:

You are exactly correct. I try to explain this to people and I get a blank stare. It is not 15% but that's what people believe and why many of them still think Plan F is "magical."

Rick

 

[policy doctor]

If doctors do not accept assignment they are not making an additional 15% more.

If they do not accept assignment Medicare reduces the amount they would usually approve by 5%. The doctor can then add 15% to the reduced amount. So, the doctor is really getting around 9.25% more instead of 15%.
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Now that is interesting. I always thought same fee schedule for a Medicare patient, whether dr. took assignment or not. That would explain why so many do take assignment. Their overage is not that much more and when you factor in billing costs...well.

Where did you find that tidbit?

 

[policy doctor]

Originally Posted by policy doctor
....what I don't get is why the doctor doesn't refuse assignment and ask for full price. then the client would pay the difference between dr's bill and Medicare 80% payment, and get reimbursed partly or wholly from ins co.



I was referring to the excess charge. Not that common.

I never get calls from clients regarding their medicare bills if they have a supplement. Very low maintenance in this dept. Now the Ma-PFFS created a stir last year, but calls have died down.

BTW...mom has Plan F. The $$$ made sense in NY, but she wants MA because her friend has one and pays nothing. Mom is healthy and never goes to drs. so she's counting that lost revenus.

 

[senior-advisor-indiana]

The doctor accepting assignment or not accepting assignment has nothing to do with billing. From the patients perspective the billing is handled by the doctors office regardless. The patient never enters into the equation.

I agree with everything you say Frank. EXCEPT.... I believe the correct term is irregardless . Do you not watch Billy Bob Thorton Movies?
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[MedSuppPro]

This week's announcement of 2009 payment rates for Medicare private health plans should help all you MA ONLY addicts.

Health insurer shares rise after Medicare delays payment adjustment until 2010 - MSNBC Wire Services - MSNBC.com

Forbes current issue states all 3 presidential candidates agree that MA's have "been an expensive boondoggle" and "could face the scalpel of a new administration in Washington."

I'll take frys and ah soda wit tat burger!