Q&A: Opting out of Medicare

December 5, 2008

If I opt out of Medicare, can I charge patients the same reimbursement rate that Medicare allows?

Q: I manage a physician office, and we have seven providers who are going to opt out of Medicare as of the first of the year. Can you confirm for me that if I have a signed contract with my existing Medicare patients, I can charge them the same reimbursement rate that Medicare allows after the first of the year?

A: It depends on what you mean by "opt out." If the physicians are truly not billing or collecting from Medicare, they can charge whatever they want, regardless of what the agency allows. The patient forfeits any payment by Medicare. But if you mean that you would bill the patient the maximum amount allowed by Medicare, you would also bill the agency for the same amount, which in turn would send a check to the patient, who would pay the physician directly. Either way you need to inform patients and get confirmation that they are responsible for the bill.

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