With the cuts to Medicare still looming large in the minds of private medical practitioners, more and more doctors are talking about simply opting out of the program. Of course, that may prove easier said than done. There are actually quite a few hoops to jump through to opt out in accordance with the law. Plus, you have to go through the whole process again every two years. You will need to make sure the extra paperwork is worth it. If you do plan to opt out, be aware that cutting corners is not an option.
The High Price Of Getting It Wrong
What’s the worst that could happen if you start accepting private payment from Medicare patients without formally opting out? You could conceivably face a fine of up to $10,000 per service provided under private contract to a Medicare patient.
If your charges are higher than those reimbursable via Medicare you could also be required to refund the balance. There are other penalties that could be assessed depending on whether the auditors believe you made a good faith effort to follow the correct protocol in opting out.
You’ve Made Your Decision – Who Needs To Know?
It isn’t just your state Medicare carrier who needs to be notified of your decision to opt out. Your patients must also be told. Besides sending a letter to your patients, post a notice in your office. In addition, you will need to create a private contract template to use with patients who are eligible for Medicare. They must agree in writing not to file any claims with Medicare for payment of any portion of the services you provide.
You also need to make absolutely sure that your staff members will not file any claims for Medicare reimbursement. Unintentional double-dipping is a sure way to get accused of fraud during an audit.
For some excellent step-by-step instructions on opting out for both participating and non-participating physicians, go here. That page also includes sample text for an opt-out affidavit and for a private contract. Just remember that you should consult with your attorney before taking the plunge to make sure you are fully protected.
Are you in the process of opting out? Tell us how that’s working out for you and if there is any additional red tape doctors should be aware of.
#1 by Chris Carraway, DC DIBCN on April 21st, 2010
Quote
Thank you for this very imformative article. I knew that there was a formal way to go about this but had no idea what the process was and how steep the fines are.
I am not ready to opt out yet. As it stands now Medicare is the best thing that we have going for us insurance wise. A 21% cut would change all that though.