Practicing in two states: Consult Medicare on office location

Beginning a full-time, house-call geriatric practice in one state while living in another creates a payment dilemma.

Moving to the state where I will be practicing is not an option. Do I have to switch management companies to one that is in the state where I render services? Or can I rent space from an assisted-living facility where I will be seeing patients? Do I have any other options?

A: Your dilemma is tricky to say the least. Unfortunately, there's no "magic bullet" answer. As you noted, there is very little information from Medicare on this subject. Although Medicaid makes provisions for providers who live close to the border, I have never heard of Medicare doing so. It appears that you are ahead of the rule-making body, because Medicare still requires practitioners to have a physical business location in each state they service. The space rental option might be feasible, but you need to discuss it with a Medicare supervisor to see whether such an arrangement qualifies.

Answers to readers' questions were provided by Thomas J. Ferkovic, RPh, MS, managing director, SS&G Healthcare Services LLC, Akron, Ohio. Send your practice management questions to

Also engage at and