Magazine article Medical Economics

Your Options with Regard to Medicare

Magazine article Medical Economics

Your Options with Regard to Medicare

Article excerpt

Q: I have seen conflicting information concerning opting out and participating versus nonparticipating status with Medicare. One article I recently read gave an example of a physician who did not accept any insurance, including Medicare, He worked in a resort area where he made house calls and accepted only cash payments for his services, yet he was part of a group practice that was participating with Medicare. Other articles I have read seem to indicate that a doctor cannot be both nonparticipating and participating. What is the real answer?

A: A physician can be both participating and nonparticipating if the physician is part of two separate tax ID entities, has been credentialed with both, and follows the rules that apply to participating versus nonparticipating (for instance, charging the limiting charge for services provided in the nonparticipating group). The designation of participating or nonparticipating applies to the group, not to the individual doctor, although he or she individually must execute the agreement as part of the group.

If a physician "opts out" of Medicare, however, the situation is different. By opting out, the doctor no longer is recognized as a provider in the program and, therefore, cannot receive any compensation from Medicare, either directly or indirectly. For instance, one physician in a group can't opt out while the rest of the group members remain either participating or nonparticipating.

The reason is that the group receives reimbursement from Medicare as a group, not as individual physicians. …

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