Should you opt out of Medicare? 7 things to know

Medscape weighed the pros and cons of opting out of Medicare for physicians.

Here are the key details to know:

1. Medicare opt outs are becoming more common. In 2016, 7,400 physicians opted out of Medicare. The types of doctors opting out of Medicare tend to be psychiatrists or primary care physicians.

2. Many physicians who opt out of Medicare do so because of its requirements, such as reporting to the Merit-based Incentive Payment System and other regulations. Physicians are fined for not following MIPS requirements.

3. By not participating in Medicare, physicians are not subject to CMS investigation for possible Medicare fraud. Physicians who participate in Medicare are audited more extensively than physicians who take only private insurers.

4. Medicare is a low reimbursing payer.

5. Cutting out Medicare patients can be a way for physicians to limit their participation in Medicare, but not stop altogether. However, practices will still be liable to Medicare regulations.

6. Specialists can lose referrals if they opt out. Some specialties such as gastroenterologists, pulmonologists and cardiologists rely on Medicare patients. Specialists do have the option to not perform procedures on Medicare's list of covered services.

7. Opting out is difficult. The whole process of opting out of Medicare can take three to four years. Opting back in can be a long, difficult process as well.

8. Employed physicians may not be able to opt out, and some groups may not allow opting out. Physicians in small practices, those with hospital privilege, independent practice associations and those wishing to spend part of their time in emergency or urgent care facilities may not be able to opt out as well.

More articles on turnarounds:
Pacira CEO David Stack says 70% of surgeries will be outpatient in 10 years — Here are the key drivers
Top 5 integrated care delivery networks by outpatient centers — HCA has 2nd most
Private equity firm acquires athenahealth for $5.7B: 6 things to know

© Copyright ASC COMMUNICATIONS 2019. Interested in LINKING to or REPRINTING this content? View our policies by clicking here.


Top 40 Articles from the Past 6 Months