Valentine’s Day last chance to break up with Medicare

January 25, 2012

This year the government is giving physicians extra time to drop their Medicare participation. But you do face one snag if you let the relationship linger too far into 2012.

The Centers for Medicare and Medicaid Services (CMS) says it will give physicians until February 14 to drop their Medicare participation agreement and become a “nonparticipating” physician. Usually, doctors have to make that change before the end of a calendar year.

“Nonparticipating” physicians may bill patients up to 115% of the Medicare-approved charge, although Medicare reimburses those patients only 95% as much as it would if they saw a participating physician, according to the American Association of Physicians and Surgeons (AAPS), a physicians’ group founded in 1943 “to preserve and promote the practice of private medicine and the sanctity of the patient-physician relationship.”

“[I]t’s not about the money. [Nonparticipating] doctors may actually collect less,” says Jane Orient, MD, executive director of AAPS, in a statement. “The main reason to take advantage of the extended deadline is that [nonparticipating] physicians are free to opt out of Medicare at any time, instead of only four times a year.”

The American Medical Association offers a Medicare Participation Calculator on its Web site to help doctors estimate how much of their total revenue from Medicare patients would change if they switch status from Medicare participation to non-participation.

If physicians become nonparticipants between January 1 and February 14, their new status is retroactive to January 1. This change could create confusion and administrative hassle if they file claims as participating doctors for any services rendered after January 1, according to the AAPS. The group suggests physicians hold claims and obtain confirmation from their carriers if they change to nonparticipating or opted-out status.

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