Medicare Balance Billing

[kgmom219]

Not a fan. At all.

So I thought I would some others, who are far more conservative than I, their thoughts.

Private Contracts Between Doctors and Medicare Patients: Key Questions and Implications of Proposed Policy Changes

 

[sshafran]

I worked in contracting (sales) for a while (roofing and siding) and as a contractor I wanted to set the price. But when doing restoration work, the insurance adjusters felt like they could determine our margins and weigh what a “fair price” was. And boy did those annoying little adjusters enjoy their power trip and the red tape any time you charged for something outside of their (inaccurate and incomplete) scope.

As a red blooded American I hated a 3rd party trying to determine my price.

I have to think doctors, at times, feel the same way - not only with Medicare patients but with any patient.

Of course, having the provider set their own pricing is a pie in the sky dream today...

 

[somarco]

On one hand it is a free market. Doctors are not required to accept Medicare patients unless they also have admitting privileges with a hospital that accepts federal funding . . . which is just about all of them.

But just as docs may choose to opt out and charge whatever they want their patients are also free to take their business elsewhere.

Here is more info on how docs can opt out.

To opt out of Medicare:

• Participating providers are only allowed to opt out at the beginning of each calendar quarter. A valid affidavit postmarked 30 days prior to the first day of each new quarter (January, April, July, or October) must be submitted.
• Non-participating physicians and practitioners have the ability to opt out at any time. However, the Opt Out effective date must be after the date the provider signs the affidavit.
• The Opt-Out contract lasts for a two-year period beginning the date the physician or practitioner files and signs an affidavit that he or she has opted out of Medicare. Then the physician or practitioner could decide to return to Medicare or to “opt out” again.
• A private contract must be entered with each Medicare beneficiary effective when the opt-out period begins.

OIG Compliance NOW - Opt-Out of Medicare Frequently Asked Questions

Isn't that special?

Some bone poppers opt out and so do many shrinks. OB docs will commonly opt out as well.