Practice Management Q&As

January 20, 2006

Medicare: Should you participate or not?

Q. Will I be reimbursed more as a participating provider with Medicare than as a nonparticipating provider?

A. You'll be reimbursed more as a participating provider. But, in theory, you'll have the potential to earn more as a nonparticipating provider, depending on whether or not you accept assignment.

On the face of it, seeing Medicare patients as a nonparticipating provider is a worse deal: Your reimbursement will be based on a fee schedule that's 5 percent lower than the amount participating providers receive for the same services. If you accept assignment (an arrangement whereby you submit the claim for the patient and Medicare sends the reimbursement directly to you), you must accept that lower amount as full payment of your services. Medicare will reimburse you 80 percent of that amount, and you must collect the other 20 percent from the patient.

However, here's where the opportunity to earn more comes in: A nonparticipating provider can decide whether to accept assignment on a case by case basis. In cases where you choose not to accept assignment, you're allowed to charge your patient 15 percent more than the nonparticipating fee schedule. Although Medicare will reimburse only the standard 80 percent of the nonparticipating fee; your patient is responsible for the remainder of your higher charge.

There's a bigger issue raised by your question, though: How many Medicare patients will you lose by opting out of the program? Probably a lot, if staying with your practice will cost them more money. Obviously, losing a chunk of your Medicare patients could wipe out any gain you may realize by being a nonparticipating provider who doesn't accept assignment.

When a dismissal notice is returned

Q. Your experts frequently stress the importance of using certified mail, return-receipt requested, to notify a patient that you're dismissing him from your practice. But often there's no one at the delivery address to sign for the letter, the intended recipient never claims it at the post office, and it's eventually returned to me. Then what?

A. Try a delivery service. If that doesn't work, send the letter again by regular mail, marked "second attempt." Document all your efforts, and keep the returned items as evidence of your attempt to reach the patient. These will help serve as your defense if the patient charges you with abandonment.

How many times should you try to reach him? The more trouble you anticipate from the patient, the greater the effort you should make to give him proper notice of his dismissal.

Charging extra for after-hours care

Q. In an emergency, I sometimes agree to see a patient when my office is closed. May I charge extra for this service?

A. You can with fee-for-service patients. And you might be able to with managed care patients, depending on your contract. But Medicare doesn't pay extra for after-hours care.

"Dictated, but not read"

Q. Our practice produces so many reports and progress notes, it's hard to find time to review them. So we often file the transcriptions in the patients' charts without reading them. We stamp them "Dictated, but not read." Any problem?