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
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