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Medicare Opt-Out a Viable Physician Strategy

Greg Freeman, April 17, 2014

"Some surgeons were doing four cases at the same time, with teams of assistants and rotating from room to room," Sapega says. "My partner and I didn't feel comfortable doing that, and we realized that it was impossible to do the quality work we wanted to do and make any money under Medicare."

The financial situation, however, accounted for only about 75% of their motivation.

"The other quarter was our fear of getting a Medicare audit and the absurd consequences that could result," Sapega says. "We did not want to be subject to the consequences of an audit where they sample some small fraction of your charts and then extrapolate that error rate over years to every Medicare patient you saw and whack you over the head with that. We asked why we would subject ourselves to that kind of heavy-handed treatment for this level of payment."

The two physicians researched the requirements for opting out and found that the process involves two key affidavits. In the first, the physician practice formally notifies carriers that it will no longer participate in Medicare. (See sidebar for more details about that form.) A second affidavit is required when the practice sees patients who are Medicare eligible. (See additional sidebar for more information.)

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1 comments on "Medicare Opt-Out a Viable Physician Strategy"


Tibor Riley (4/17/2014 at 11:44 AM)
These two physicians are PEDIATRIC surgeons. Generally pediatricians don't deal with Medicare,which is mainly for the elderly. This is why pulling out of Medicare for them doesn't cause much problem. As for administrative requirements, I find the requirements from private insurance far more cumbersome. Medicare rarely denies claims; private insurance does frequently.