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Medicare Opt-Out a Viable Physician Strategy

Greg Freeman, April 17, 2014

"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.

One surprise for Sapega and Sidor was that opting out is not a one-time event. CMS requires physicians to opt out every two years, or else the system will suck them right back in. Sapega's office administrator keeps a reminder on her calendar that prompts her to file the appropriate paperwork every two years. The affidavit signed by Medicare-eligible patients must also be resubmitted every two years. If a physician fails to renew the opt-out, CMS considers the doctor to be participating in Medicare; if that happens, the opt-out process can take two years to complete.

When Sapega and Sidor first opted out 12 years ago, their move was considered radical. But now Sapega says he's hearing of a growing interest in the strategy.

"The government is embarrassed by physicians who opt out, because they can't imagine that Medicare is that bad," he says. "More are considering it as Medicare has gotten worse and our overhead has gotten higher and higher. The sustainable growth rate hanging over our head also has people concerned."

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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.