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Old 11-18-2015, 12:22 PM
 
Location: Retired in VT; previously MD & NJ
14,267 posts, read 6,916,557 times
Reputation: 17873

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While researching Part D drug plans, I noticed this on the Medicare web site:

https://www.medicare.gov/part-d/cove...-coverage.html

Quote:
Starting in early 2016, in most cases, your prescribers need to be enrolled in Medicare or have an “opt-out” request on file with Medicare for your prescriptions to be covered by your Medicare drug plan. If your prescriber isn’t enrolled or has “opted-out,” you’ll still be able to get a 3-month provisional fill of your prescription. This will give your prescriber time to enroll, or you time to find a new prescriber who’s enrolled. Contact your plan or your prescribers for more information.
One more hassle for us and our doctors.
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Old 11-19-2015, 04:07 AM
 
3,613 posts, read 4,103,797 times
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Oh, but Medicare is such a great plan....why people keep saying this, I don't know. This is what will happen under a "single payer" plan too.....
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Old 11-19-2015, 05:57 AM
 
469 posts, read 758,084 times
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This scenario is putting the cart before the horse. Any doctor who accepts Medicare has opted-in. A doctor who has opted-out of Medicare does not accept Medicare patients or makes them pay full cash price for the office visit and sign a form stating they know the doctor has opted-out.

There are few reasons why a person on Medicare would obtain a prescription from a doctor who doesn't accept Medicare.

Opting Out of Medicare: a guide for physicians
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Old 11-19-2015, 10:18 AM
 
Location: Retired in VT; previously MD & NJ
14,267 posts, read 6,916,557 times
Reputation: 17873
Quote:
Originally Posted by SCGamecock View Post
This scenario is putting the cart before the horse. Any doctor who accepts Medicare has opted-in. A doctor who has opted-out of Medicare does not accept Medicare patients or makes them pay full cash price for the office visit and sign a form stating they know the doctor has opted-out.

There are few reasons why a person on Medicare would obtain a prescription from a doctor who doesn't accept Medicare.

Opting Out of Medicare: a guide for physicians
Docs don't have to opt in to Medicare. Before I moved, my doc was not a Medicare doc, but she did accept Medicare Assignment. That means she accepted the Medicare-approved price for visits, procedures, etc. Looks like she will now have to file an opt-out form. My new doc is a Medicare doc.

I think this new opt-out refers only to Part D, but not sure.

I suspect they want the docs on a list to help reduce fraud. A lot of medicare fraud comes from docs and medical supply companies. They might also be setting up a database that can later be searched for docs who over-prescribe or patients who doctor-shop to get meds they shouldn't have.
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Old 11-19-2015, 11:06 AM
 
469 posts, read 758,084 times
Reputation: 670
Quote:
Originally Posted by ansible90 View Post
Docs don't have to opt in to Medicare. Before I moved, my doc was not a Medicare doc, but she did accept Medicare Assignment. That means she accepted the Medicare-approved price for visits, procedures, etc. Looks like she will now have to file an opt-out form. My new doc is a Medicare doc.

I think this new opt-out refers only to Part D, but not sure.
If a provider submits claims to Medicare they have "opted-in." There are 4 types of providers in the eyes of Medicare.

1. Participating - These providers have signed a contract with Medicare (opted-in), accept assignment, and accept the Medicare approved amount as payment in full.

2. Non-Participating/Accepts Assignment - These providers have opted-in by submitting the claim, and accept assignment.

3. Non-Participating//Not Accepting Assignment - These providers have opted-in by submitting the claim but can balance bill an additional 15% above the Medicare Fee Schedule rate, called Part B Excess Charges.

4. Opted-Out. The opt-out provision has been around for many years and before Part D.

Quote:
Provisions in the Balanced Budget Act of 1997 give physicians and their Medicare patients the freedom to privately contract to provide health care services outside the Medicare system. Private contracting decisions may not be made on a case-by-case or patient-by-patient basis, however. Once physicians have opted out of Medicare, they cannot submit claims to Medicare for any of their patients for a two-year period.

As of September 2013, among all U.S. physicians in clinical practice, less than 1 percent (4,863) have signed affidavits with Medicare indicating that they have “opted out” of the Medicare program.

Medicare does not reimburse either the physician or the Medicare patient for any services provided by physicians who have opted out of the Medicare program. Opt-out physicians must tell their Medicare patients that they have opted out of Medicare and provide them with a document stating that Medicare will not reimburse either the physician or the patient for any services furnished by opt-out physicians. Medicare patients must sign this document to signify their understanding of it.
More info: ProducersWeb - Health - Understanding Medicare Part B excess charges

Each Medicare Part B Claims Processor maintains a list of opt-out providers. You can search the VT opt-out list here (just enter the first letter of last name): https://www.ngsmedicare.com/ngs/port...risdiction%20K

Last edited by SCGamecock; 11-19-2015 at 11:34 AM..
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