Valentine's Day Could Be Medicare Freedom Day for Doctors and Patients

TUCSON, Ariz., Jan. 6, 2012 /PRNewswire-USNewswire/ -- The Centers for Medicare and Medicaid Services (CMS) has announced the unprecedented step of allowing doctors until Feb. 14 to drop their Medicare participation agreement and become a "non-participating" physician. Usually, doctors have to make that change before the end of a calendar year.

The reason is that Congress gave only a two-month reprieve from a scheduled fee cut of nearly 30%, and no one knows what will happen at the end of that period on March 1. Since physicians' expenses run at least 50% of revenue, and often much more, doctor's pretax income from attending Medicare beneficiaries could be cut by 60% or more.

"Non-participating" physicians may bill patients up to 115% of the Medicare-approved charge, although Medicare reimburses patients of such physicians only 95% as much as it would if they saw a participating physician. The AMA and others are providing calculators to help physicians figure out whether they can make more money by going "non-par."

"But it's not about the money. Non-par doctors may actually collect less," states Jane Orient, M.D., executive director of the Association of American Physicians and Surgeons (AAPS). "The main reason to take advantage of the extended deadline is that non-par physicians are free to opt out of Medicare at any time, instead of only four times a year, at the beginning of a quarter."

Thousands of physicians have opted out of Medicare so that they can see to their patients without the Byzantine, increasingly costly and punitive Medicare rules.

If physicians become non-par between Jan. 1 and Feb. 14, their new status is retroactive to Jan. 1. This could create much confusion and administrative hassle if they file claims as participating physicians for any services rendered after Jan. 1. AAPS suggests holding claims until the physician's status is clear. Also, it is impossible to be sure the claim is for the proper amount when even CMS doesn't know what the allowed fee will be.

AAPS urges physicians to obtain confirmation from their carrier if they change to non-par or opted-out status. Carriers have been known to lose documentation, and force physicians to do enormous amounts of work to refund payments and re-file claims.

AAPS offers extensive information on how to opt out of Medicare http://www.aapsonline.org/index.php/site/article/opt_out_medicare/, including a list of Medicare carriers http://www.cms.gov/MedicareProviderSupEnroll/downloads/contact_list.pdf. It also provides links to carriers' lists of opted-out physicians, for patients who prefer a private physician or who can't find a participating physician who is willing to accept a new Medicare patient, https://spreadsheets.google.com/pub?key=0Aqnmn7qC9bcHdHpLZlR0dTczNm82dkRfZFd3MjI5dWc&output=html as well as a list of its own members who are opted out of Medicare and are willing to privately contract with Medicare eligible patients. https://aaps.wufoo.com/reports/m5p6z0/.

"Opting out may be the only way a physician can keep his office open, and still be able to serve Medicare-eligible beneficiaries," states Dr. Orient. "Without the crushing Medicare compliance costs, physicians can offer personalized, excellent care at a very reasonable price."

AAPS, a national organization of physicians in all specialties, was founded in 1943 to preserve and promote the practice of private medicine and the sanctity of the patient-physician relationship.

SOURCE Association of American Physicians and Surgeons (AAPS)

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