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Medicare Opt-Out a Viable Physician Strategy

Greg Freeman, April 17, 2014

Sapega cautions that practices opting out of Medicare must be diligent about having Medicare-eligible patients sign the affidavit acknowledging the opt-out. Failing to do so and then treating that patient anyway could open you up to charges of fraud and possible investigation.

After submitting the opt-out affidavit, Sapega and Sidor's practice was officially out of the Medicare game, eliminating about 12% of their current patient population. The Medicare patients were missed, but their revenue was not critical to the success of the practice, Sapega says. Other practices with larger Medicare populations might have a harder time making up the difference if they were to opt out, he notes.

"We price our services right around the usual and customary figure, neither high nor low," he says. "If the payer pays 60%, that's fine, but we expect the patient to pay the rest of it."

"The only way we could do that was to try to get closer to usual and customary reimbursement and not these crazy discounts based on Medicare," he says

Opting out of Medicare allowed Sapega and Sidor to concentrate more on patient care rather than maximum productivity-in effect creating a more selective, boutique practice. They now schedule a 60-minute visit for new patients and 15- or 30-minute follow-up visits as part of their effort to provide more personalized care.

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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.