Nationally, patient and physician surveys and Medicare’s administrative data show that most Medicare patients enjoy good access to physicians and most physicians are accepting new Medicare patients. Moreover, survey findings reveal that Medicare beneficiaries and adults with private insurance report similar access to physicians. While the majority of Medicare beneficiaries report having a usual source of care and do not forego needed physician visits, certain subgroups of Medicare beneficiaries have higher rates of access problems that warrant close attention. These include beneficiaries with no supplemental insurance or Medicaid, beneficiaries under age 65 living with a permanent disability, beneficiaries in fair and poor health, beneficiaries with four or more chronic conditions, and beneficiaries with lower incomes. For the most part, however, even among these subgroups, most do not report significant problems securing access to medical care when needed. Physician surveys and Medicare data tell a complementary story to the patient surveys. Overall 91 percent of physicians report taking new Medicare patients—comparable to the rate for new private non-capitated patients. About 1 percent of physicians have formally opted-out of the Medicare program to contract privately with all their Medicare patients, with psychiatrists comprising the largest share. Factors that influence physician decisions about acceptance of new patients can be strongly influenced by local health market circumstances that cannot be ascertained from state-level data. Further research is needed at a more local level to understand how access is affected by other factors including provider supply, other insurer interactions, changes in group practice dynamics, and patient demand for medical services. Survey instruments could be improved to determine if doctors in open practices access some or all new patients, by type of insurance. While this paper focuses mostly on physicians, the number of other health professionals who provide care to Medicare patients—such as nurse practitioners and physician assistants—has grown rapidly over the past decade.
Opting Out of Medicare: a guide for physicians
I, ______, declare under penalty of perjury that the following is true and correct to the best of my knowledge, information, and belief: 1. I am a physician licensed to practice medicine in the state of ______. My address is at _________, my telephone number is _________, and my [national provider identifier (NPI) or billing number, if one has been assigned, uniform provider identification number (UPIN) if one has been assigned, or, if neither an NPI nor a UPIN has been assigned, my tax identification number (TIN)] is _________. I promise that, for a period of two years beginning on the date that this affidavit is signed (the “Opt-Out Period”) and continuing indefinitely with automatic extensions of the 2-year opt out period unless terminated by me as allowed by Title 1 Section 106(a)(1) Medicare Access and CHIP Reauthorization Act of 2015, I will be bound by the terms of both this affidavit and the private contracts that I enter into pursuant to this affidavit. [NOTE: Your personal UPIN number must be used, not a corporate UPIN number. Persons opt out, not corporations.] 2. I have entered or intend to enter into a private contract with a patient who is a beneficiary of Medicare (“Medicare Beneficiary”) pursuant to Section 4507 of the Balanced Budget Act of 1997 for the provision of medical services covered by Medicare Part B. Regardless of any payment arrangements I may make, this affidavit applies to all Medicare-covered items and services that I furnish to Medicare Beneficiaries during the Opt-Out period, except for emergency or urgent care services furnished to Beneficiaries with whom I had not previously privately contracted. I will not ask a Medicare Beneficiary who has not entered into a private contract and who requires emergency or urgent care services to enter into a private contract with respect to receiving such services, and I will comply with 42 C.F.R. § 405.440 for such services. 3. I hereby confirm that I will not submit, nor permit any entity acting on my behalf to submit, a claim to Medicare for any Medicare Part B item or service provided to any Medicare Beneficiary during the Opt-Out Period, except for items or services provided in an emergency or urgent care situation for which I am required to submit a claim under Medicare on behalf of a Medicare Beneficiary, and I will provide Medicare-covered services to Medicare Beneficiaries only through private contracts that satisfy 42 C.F.R. § 405.415 for such services. 4. I hereby confirm that I will not receive any direct or indirect Medicare payment for Medicare Part B items or services that I furnish to Medicare Beneficiaries with whom I have privately contracted, whether as an individual, an employee of an organization, a partner in a partnership, under a reassignment of benefits, or as payment for a service furnished to a Medicare Beneficiary under a Medicare+Choice plan, during the Opt-Out Period, except for items or services provided in an emergency or urgent care situation. I acknowledge that, during the Opt-Out Period, my services are not covered under Medicare Part B and that no Medicare Part B payment may be made to any entity for my services, directly or on a capitated basis, except for items or services provided in an emergency or urgent care situation. 5. A copy of this affidavit is being filed with [the name of each local Medicare carrier], the designated agent of the Secretary of the Department of Health and Human Services, no later than 10 days after the first contract to which this affidavit applies is entered into. [FOR PARTICIPATING PHYSICIANS ONLY: My Medicare Part B Participation agreement terminates on the effective date of this affidavit.] Executed on [date] by [Physician name] [Physician signature]
Medicare.gov Physician Compare Home Page
Avoid Medicare Fraud Claims by Coding Correctly
You may believe you are beyond reproach if you don’t order a mobile scooter for every patient or dump your patient records in the nearest landfill, but you should exercise caution in these cautionary times: what the feds consider “fraud” is much broader than your definition. E&M coding, for instance is a potential target; the 99213 and 99214 office follow-up codes were the top two CPT codes in terms of both charges and unit volume in 2010. Don’t let your practice be caught up in Medicare’s recovery program. It’s a simple matter to examine your own coding patterns and compare them to national utilization data collected by Medicare. Knowing how you compare to others within your specialty is important in assessing possible exposure to recovery efforts.
Primary care physicians now accepting new Medicare plans :: News of the Week
As a result, the primary care group is working together to enhance access to patients’ personal physicians and make Loma Linda University Health’s offices, phones, website and other services easy to use as the organization moves forward with a new focus to enhance patient satisfaction and accessibility.