If I Opt Out of Medicare Can I Still See Medicare Patients for Podiatry House Calls?

Yes! In fact far more profitably.

You can (and likely will) see Medicare patients if you opt out of Medicare. However you will not be restricted to charging Medicare allowable rates. You can charge whatever is appropriate for your time. You can charge a house call fee sufficient to provide caring, non-–rushed care for your elderly patients. And you will not have to wait for Medicare to pay you.


If you have previously accepted Medicare and then opted out of Medicare (after you realized that it was very difficult to offer high-quality caring interactions at low Medicare reimbursement rates), you must notify every medicare-eligible patient that you have Opted Out of Medicare. When you see a Medicare patient after you have opted out of Medicare you are entering into a private contract. The following are conditions and requirements of a private contract between the physician (you) and the Medicare “beneficiary” (the patient).

REQUIREMENTS OF A PRIVATE CONTRACT BETWEEN THE PHYSICIAN/PRACTITIONER AND BENEFICIARY:

• Be in writing in print sufficiently large to ensure that the beneficiary is able to read the contract
• Clearly state whether the physician or practitioner is excluded from Medicare.
• State that the beneficiary or his or her legal representative accepts full responsibility for payment for the physician’s or practitioner’s charge for all services furnished by the physician or practitioner.
• State that the beneficiary or his or her legal representative understands that Medicare limits do not apply to what the physician or practitioner may charge for items or services furnished by the physician or practitioner.
• State that the beneficiary or his or her legal representative agrees not to submit a claim to Medicare or to ask the physician or practitioner to submit a claim to Medicare.
• State that the beneficiary or his or her legal representative understands that Medicare payment will not be made for any items or services furnished by the physician or practitioner that would have otherwise been covered by Medicare if there was no private contract and a proper Medicare claim had been submitted.
• State that the beneficiary or his or her legal representative enters into the contract with the knowledge that he or she has the right to obtain Medicare-covered items and services from physicians and practitioners who have not opted out of Medicare, and that the beneficiary is not compelled to enter into private contracts that apply to other Medicare- covered services furnished by other physicians or practitioners who have not opted out.
• State the expected or known effective date and expected or known expiration date of the opt-out period.
• State that the beneficiary or his or her legal representative understands that Medigap plans do not, and that other supplemental plans may elect not to, make payments for items and services not paid for by Medicare.
• Be signed by the beneficiary or his or her legal representative and by the physician or practitioner.

Here is a copy of the exact form I use to notify patients I have opted out of Medicare:

Medicare Opt-Out Agreement form

Please note: You are required to have your patients sign a new contract every two years.  I simply have every Medicare patient sign a copy every year whenever I see them.

Check with your Health Care Attorney to make sure you are in complete compliance.

KEEP ORIGINAL COPIES of forms!  Retained original signatures of both parties are required by the physician for the duration of the opt out period (as in forever). These must be made available to CMS upon request. Place a copy in the patients new patient folder at their initial visit before items or services are furnished to the beneficiary under the terms of the contract.

Dr. Christopher Segler is not a health-care attorney and is not offering legal advice.  However he is a successful Concierge Care House Call Podiatrist who figured out how to help patients by offering cash-based services free of insurance-related hassles under a simple house call practice model.  If you have a question about how to start a profitable, low-stress podiatry housecalls practice, you can reach him directly at 415–308–0833 

Do I Need an Office for Podiatry House Calls?

No.  And seriously...why would you want one?

To be realistic, lets look at what you get when you decide to set-up a podiatry office or store-front location. You now get to pay rent. You get to pay paychecks (that you write of course, out of your own bank account) to nurses, medical assistants and office staff. 

Then of course you will need insurance, too. So you buy renter’s insurance to insure the property in the office is covered against theft, fire, vandalism, etc. You will buy slip and fall insurance to protect you from the out-of-work opportunist/scam artist who perceives you to be rich and therefore someone who might want to pay out rather than fight a frivolous lawsuit. You will need to buy workman’s compensation insurance to cover the salary of that perpetually late and/or rude employee you need to fire. And let’s not figure waiting room furniture and all of those podiatry chairs that each cost about as much as a small car. 

If spending all of you income on an office fun to you, then by all means, open a brick-and-mortar podiatry office.

But if you plan on doing house calls, keep in mins that all of those expenses will cost you, even while not use...as in all the time you are out doing house calls. 

If your brick-and-mortar office overhead expenses run at $100 per hour than you have to make $100 per hour every hour while out of the office just to cover the office expenses. 

If your total office expense are more like $200-$500 per hour, better drive fast. 

When you eliminate all of that useless office overhead, it suddenly becomes much easier to make a real profit doing podiatry house calls. 

I am not trying to contend that office setting aren’t useful for most practices. I am only pointing out that when you choose a podiatry practice model based on direct pay, house calls and increased physician access, an office is a lability and not asset.

The podiatrist who believes he needs an office in which to see “serious cases” such as infections, diabetic emergencies and the like, is fooling himself. Serious cases don’t need an office, they need a hospital. 

Think about an urgent issue that a podiatrist discovers in a nursing home. The Podiatrist doesn’t take the nursing home patient back to the office...he treats the patient right there, or admits the patient to the hospital. 

This certainly more closely follows the course of a podiatry house call practice. 

You certainly need to consider whether or not your target market is really patients who want to visit an office for care, or patients who want to have their care delivered to them at home. 

If you think your market is BOTH, you will likely find little success in either. 

Choose wisely, but choose one. 

Dr. Christopher Segler is a podiatrist who started a house calls based podiatry practice from scratch. He designed an insurance-free practice model that works and is profitable much earlier than a conventional podiatry office practice model. After working out the kinks, you has shared his recipe for house call success with a limited number of podiatrist. If you are considering building a house calls based podiatry practice, and wonder if it would work for you in your community, you call reach him directly at 415-308-0833. 

10% of Docs Expected to Stop Taking Taking Insurance in Next 3 Years!

If there was ever a great reason for the timid to start a concierge podiatry practice, this would be it.

A recent article in Forbes discussed reasons why so many docs are planning to go insurance-free in their practices. It is not just fed-up, frustrated and overwhelmed primary care doctors. The AMA says it is across the board. All medical specialities have doctors who now believe running a practice free of third-party insurance reimbursement hassles is the most profitable and best way to go.

An independent research firm claims 9.6% of all doctors plan to switch to direct-pay models of practice in the next 1 to 3 years.

If you are a podiatrist who has historically relied on a group of primary care providers to funnel patients into your waiting room, this is good news.

Birds of a feather...

If you are the only podiatrist in your area who accepts NO insurance, you are the obvious best referral option.

Concierge docs are often viewed as forward-thinking independent risk takers. However the reality is that they aren't really taking big risks eliminating slow-paying third-party payments. They get paid immediately and consistently. The accounting is much simpler. The profit is higher. Life is better.

All of the decreases in time spent on the business side translate into increases in time on the patient care side. There is more time to research new procedures and better techniques. There is more time to respond to patient questions and make podiatry house calls for patients in your practice.

When a podiatrist opts-out of Medicare and stops taking insurance, the primary care doctors all know you are going to provide a higher level of attention than someone who is worried about reimbursement issues based on low-paying insurance contracts.  This alone would be reason enough for them to begin referring their clients to you for podiatric care.

So if you have been thinking about making the switch from a high hassle/low reimbursement model to a low-overhead/high satisfaction podiatry house calls practice, now would seem to be the time.

Dr. Christopher Segler used to take Medicare and insurance. But one day he woke up. After of years enjoying his podiatry house calls practice model in the San Francisco Bay Area, he has been approached by podiatrists all over the country asking one simple question, "Could a house calls based podiatry practice work for me in my area?" And the answer so far, in every case, has been YES! He now often helps other podiatrists set up and get their house calls practices started. If you have a question, you can reach him directly at 415-308-0833. You can view his practice websites at AnkleCenter.com DocOnTheRun.com and LaserToenailHouseCalls.com