In a June 28 e-mail to physicians, CMS is offering “the opportunity to become participating,” and “this opportunity is available through July 16, 2010.” Usually, physicians can change their Medicare status only at specific times of the year.
There are reasons to become participating again. Non-participating physicians get 95 percent of the participating physician’s fee and the Medicare payment goes to patients, forcing the physicians to collect it from them. In return, however, the non-participating physician can bill the patient extra, but the amount cannot be more than 115 percent of the Medicare reimbursement.
CMS offer is “almost comical”
However, the CMS offer is not very useful and probably will not get a whole lot of takers, predicts Russell B. Still, executive vice president of Medical Management Associates, an Atlanta-based physician practice management company. “It’s almost comical,” he said. Even though non-participating physicians get a lower Medicare reimbursement, they are still getting the 2.2 percent increase, so nothing changes for them, he says. They do not fall behind under the new fee increase.
And “the reasons they switched to non-participating status still stand,” Mr. Still says. Physicians switched to “non-par” status because they were betting they could collect enough fees from patients to make up for the loss of 5 percent of the Medicare fee, and then some. Collecting from the patient is easier for primary care physicians, whose fees are relatively low and can be collected at the time of the office visit, he says.
Surgeons, on the other hand, are unlikely to become non-participating, he says. Because the surgery patient often goes to the hospital for the operation and the bill is much higher, it’s harder for surgeons to collect from them. Also, the non-participating physician has to maintain two separate fee schedules, which is confusing for billing operations. One fee schedule is for the rate billed to private-pay patients and the other is for Medicare patients, reflecting the 115 percent limit. In contrast, participating physicians do not have to maintain a separate fee schedule because Medicare will accept claims with the private pay rate and simply pay the Medicare rate, he says.
Other ways to be shielded from Medicare
But there are other ways for physicians to insulate themselves from Medicare payments, Mr. Still says. One common way is to limit the number of Medicare patients in the practice, which works long as it is not discriminatory, Mr. Still says. Physicians can also opt out of Medicare, which is a much more radical step. Opting out means neither the physician nor the patient can charge Medicare anything, and physicians can charge the patient whatever rate they see fit.
Oh, and the CMS offer has one other limitation: The change in status applies to claims submitted after the application is processed and approved by CMS. “Claims previously submitted and processed will not be adjusted,” CMS said.
If you still want to switch to participating status, CMS offers the form for the Medicare Participating Physician or Supplier Agreement (Form CMS-460) on the following link: http://www.cms.gov/cmsforms/downloads/cms460.pdf
Reach Mr. Still at rbs@medicalmanagement.com
Visit the website of Medical Management Associates.
