Plan N Co-payment

[billyg]

But if they take a 20% or so cut from not implementing the doc fix, can they make it up, at least somewhat, by excess charges?

You need to understand the mechanics of how excess charges work. First, the Doctor will not recieve payment from Medicare. In order for a Medicare participating doctor to collect excess charges, he must: 1) file the Medicare claim for the patient 2) bill the patient directly for the medicare approved amount + excess charges (capped at 15% above approved amount) 3) enter into his own collections process to get the money from his patient.

Because of the limited amount of excess charges and the risk associated with collecting directly from the patient (rather than Medicare), it almost never makes econimoc sense for a Doctor not to accept assignment.

I think the bigger issue with Doc Fix is that most new doctors are refusing to participate in Medicare all together, and even many established doctors are refusing to accept new Medicare patients. As a result, qualified medical care is becoming more difficult to find for everyone over 65. If they don't come up with a permanent fix for the fee schedule, in time Medicare Part B will be all but useless because no Doctor will accept it.

 

[moonlightandmargaritas]

But if they take a 20% or so cut from not implementing the doc fix, can they make it up, at least somewhat, by excess charges?

No Dan, they can't.

If they do not accept Medicare assignment, they are limited by law to charging a maximum of 115% of the Medicare-approved amount.

That's why excess charges are rarely a "big deal".

 

[jdeasy]

No Dan, they can't.

If they do not accept Medicare assignment, they are limited by law to charging a maximum of 115% of the Medicare-approved amount.

That's why excess charges are rarely a "big deal".

That and the trouble with the billing. I have never had an issue with excess in this area. Recently I had one of my clients that ran into the only, apparently, doctor in western Ky. that charges the excess. My client is on plan F, so, it was all paid, but, he was frustrated with the payments coming to him and he had to forward to the doctor. He is not going to use that doctor anymore just because of the trouble.

 

[somarco]

I think the bigger issue with Doc Fix is that most new doctors are refusing to participate in Medicare all together, and even many established doctors are refusing to accept new Medicare patients. As a result, qualified medical care is becoming more difficult to find for everyone over 65. If they don't come up with a permanent fix for the fee schedule, in time Medicare Part B will be all but useless because no Doctor will accept it.

I know a lady that is an office manager for a pain management clinic. Most of their pts are on Medicare.

The practice where she works has been experiencing declining revenues against rising expenses for the last 2 years. While many PCP's try to limit their Medicare pt load to 10% or less, some are willing to go higher, in the 15% or so range.

This practice has over 60% and they are not accepting new Medicare pts.

 

[Frank Stastny]

You need to understand the mechanics of how excess charges work. First, the Doctor will not recieve payment from Medicare. In order for a Medicare participating doctor to collect excess charges, he must: 1) file the Medicare claim for the patient 2) bill the patient directly for the medicare approved amount + excess charges (capped at 15% above approved amount) 3) enter into his own collections process to get the money from his patient.

The doctor will also not receive payment directly from the insurance company. The 15% is not a true 15% because if the doctor does not Accept Assignment Medicare reduces the amount they would normally approve by 5%. Then the doctor can add the 15% to the reduced amount.

Because of the limited amount of excess charges and the risk associated with collecting directly from the patient (rather than Medicare), it almost never makes econimoc sense for a Doctor not to accept assignment.

I agree.

I think the bigger issue with Doc Fix is that most new doctors are refusing to participate in Medicare all together, and even many established doctors are refusing to accept new Medicare patients. As a result, qualified medical care is becoming more difficult to find for everyone over 65. If they don't come up with a permanent fix for the fee schedule, in time Medicare Part B will be all but useless because no Doctor will accept it.

I don't know what you are basing your statements on. Please don't refer me to the occasional article or interview with an individual doctor or two or an editorial by some reporter.

I'd like to see accurate hard facts and statistics, all documented, from a nation wide study showing total number of doctors in the US, 918,000 as of 2005, and the accurate number of those who have, as a matter of policy, stated that they refuse to see any patient who is on Medicare. It would also be helpful to see those same numbers from ten years ago to be able to compare them to the numbers today.

You are saying that “most new doctors are refusing to participate in Medicare”. Are you talking about doctors nation wide? Where are you getting this information? “Most” implies over 50%. Most new doctors will see anyone who walks through the door to get their practice started.

There are a number of doctors, not "most", who won't see patients who are on Medicaid but this isn't something that is new. There are also some doctors that will not take on any new patients and some who have placed a limit on the number of Medicare patients they will see. However, it is not “most” of them.

There is an occasional editorial by some reporter or interview with a doctor who claims to have issues with Medicare. There is a clinic in AZ that, as a two year experiment, has stopped seeing patients on Medicare but I would hardly call that either "most" or "many" doctors or even a nation wide trend.

Doctors are not going to stop seeing patients who are on Medicare. Medicare is not going to cut doctors pay when they see patients who are on Medicare. This issue comes up almost every year. Every year it is "big news" and everyone runs around yelling "the sky is falling". Then, a month or two later they "change their mind". It's almost become like an April Fools joke.

The senior population is going to double in coming years. Does anyone really believe that Medicare or the medical profession is going to leave them stranded without the availability of health care?

In the last couple of years Medicare has initiated protocols for many conditions that if the doctors will follow them they receive a bonus from Medicare at the end of the year.

 

[somarco]

http://www.nytimes.com/2009/04/02/business/retirementspecial/02health.html?_r=1

Texas doctors fleeing Medicare in droves | Houston & Texas News | Chron.com - Houston Chronicle

http://healthpolicyblog.mayoclinic.org/2010/01/05/medicare-and-mayo-clinic-in-arizona/

http://www.foxnews.com/opinion/2010/01/14/c-l-gray-medicare-doctors-deserting-obama/

 

[Frank Stastny]

http://www.nytimes.com/2009/04/02/business/retirementspecial/02health.html?_r=1

Texas doctors fleeing Medicare in droves | Houston & Texas News | Chron.com - Houston Chronicle

Medicare and Mayo Clinic in Arizona « Health Policy Blog

FOXNews.com - Why Doctors Are Abandoning Medicare

All of that is very interesting information. Thanks for sharing.

Regarding the article about Texas doctors:

In fiscal 2008 3,621 doctors were licensed in Texas.

The article you posted said that “more than 300 doctors have dropped the program in the last two years”. That is less than 8.7% of the total doctors in the state in a two year period. One can project that into the future but it is nothing more than a guess. Hardly something to be overly concerned about at this time.

They obviously were going for sensationalism by not telling "the rest of the story".

The articles about the clinic in AZ is old news. The original article stated that it was for a limited two year period, not a "done deal" or that it constituted something that the Mayo clinic was going to do nation wide. (See below for the whole story.)

The article you posted specifically stated the following:

“This means that Medicare will no longer reimburse Mayo Clinic for primary care services at this specific primary care facility, not at Mayo Clinic in Arizona overall. This affects only primary care office visits for the five Mayo family practice physicians at this site. Specialty care, laboratory services, imaging studies and ancillary services at Mayo Clinic are still covered by Medicare”.

 

[somarco]

Docs increasingly abandon Medicare | MassDevice - Medical Device Industry News

The Centers for Medicare and Medicaid Services says that 97 percent of physicians accept Medicare patients, but the agency doesn't know how many have refused to take new Medicare patients

The American Academy of Family Physicians said 13 percent of doctors did not participate in Medicare last year, according to the paper, up 8 percent from 2008 and 6 percent from 2004. The American Osteopathic Assn. said 15 percent of its members don't participate in Medicare and 19 percent don't accept new Medicare patients. If the 21 percent cut becomes permanent, the AOA estimated that those numbers would double, USA Today reported. The American Medical Assn. cited a survey of 9,000 members that found that 17 percent restrict the number of Medicare patients in their practice. Among primary care physicians, the rate is 31 percent.

- - - - - - - - - - - - - - - - - -
The USA Today link.
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Additional results from our (AMA) survey find that even with a temporary action, physicians say they will be forced to limit the number of Medicare patients they can treat. Our new survey shows that if Congress enacts a short-term delay of four to seven months, 54 percent of physicians say they will limit the number of Medicare patients they can treat. Even if Congress enacts a three to five year delay of the cut, 48 percent will limit the number of Medicare patients they treat.

 

[bourbonlegend]

I am comfortable selling ACI "N" plans to some select clients. I would NEVER sell a u of o "N" plan unless the client absolutely could not qualify for anything else.

I have never (knock on wood) had an "F" plan replaced by anyone (have hundreds on the book). People buy 100% coverage for a reason.

In my opinion agents selling d and g plans by glossing over the part b excess are setting themselves up to have policies replaced

 

[GreenSky]

In my opinion agents selling d and g plans by glossing over the part b excess are setting themselves up to have policies replaced

Just how many of your clients have been "bit" by excess charges? How many of those had to pay more than $50?

My thinks you just don't understand excess charges.

Rick