The 2016 Physician's Guide to Opting Out of Medicare

8/15/2019 The 2016 Physician's Guide to Opting Out of Medicare

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Opting Out ofMedicare

AAPSThrive – Not Just Survive XXIV Workshopa!!as" Te#as$%&'$&'$()

*a+rence ,- .untoon" M--" Ph--Association of A/erican Ph0sicians and Surgeons


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Reasons for

Opting Out ofMedicare


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Physician Burnout Climbs 10% in 3 Years!its ""%

#Professional burnout among $ physicians hasreached a dangerous le&el 'ith more than halfof physicians a(ected according to the results

of a )01* national sur&ey across &ariousmedical specialties and practice settings+Compared 'ith responses from a similar sur&eyin )011 burnout and satisfaction 'ith 'or,-lifebalance ha&e 'orsened dramatically e&enthough 'or, hours ha&e not increased o&erall+.

Physician Burnout Climbs 10% in 3 Years !its ""%

By /iana 'ift

Medscape eurology/ecember 1 )01"


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Physician Burnout#he pre&alence of burnout is higher in

physicians than in other professions and isespecially high in neurologists+ Physicianburnout encompasses 3 domains2 1(2 emotional ehaustion2 the loss of interest andenthusiasm for practice4 1'2 depersonali5ation2a poor attitude 'ith cynicism and treatingpatients as ob6ects4 and 132 careerdissatisfaction2 a diminished sense of personalaccomplishment and lo' self-&alue+ Burnout

results in reduced 'or, hours relocationdepression and suicide+ 4urned&outph0sicians har/ patients 5ecause the0!ack e/path0 and /ake errors-6

Ph sician Burnout2 7 eurolo ic Crisis


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;!Rs are a Ma6or Contributing


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ncreasing Bureaucracy isa Ma6or Contributor

o

Physician Burnout


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Medicare

Obstructs mpedes andnterferes

'ith

early ;&ery 7spect

Of

he Practice of Medicine


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# 'ould really lo&e to Opt Out ofMedicareD

B$ really canEt do it in my areaD amsurrounded by competitors all of 'homparticipate in MedicareDand all of myMedicare patients 'ill lea&e and go tomy competitors if Opt Out and 'ill beout of business+.


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he Pin,y oe 7pproach to OptingOut

?est the 'ater temperature by dipping yourpin,y toe in the 'ater before di&ing into thepool@

Conduct a brief 'ritten Surve0 of Medicarepatients as they come into your oFce+

Surve0 ser&es a dual purpose G helps to

educate your patients about ho' the Medicarebureaucracy ad&ersely a(ects them andinforms them about the substantial bene=ts ofbeing treated by an Opted Out /octor+


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he Medicare bureaucracy is increasingly forcing ourphysicians to spend more and more time onadministrati&e reHuirements that ha&ing nothing to do'ith pro&iding you 'ith Huality medical care+ pendingmore time on bureaucracy means spending less time'ith indi&idual patients+ Medicare also coercesphysicians to ser&e as agents for rationing medical careso as to sa&e the go&ernment money+ he MedicareProgram obstructs impedes and interferes 'ith our

ability to pro&ide our patients 'ith good care+ Ourphysicians do not 'ant to ser&e as agents of rationing forthe Medicare program+ n order to be able to pro&ide you'ith timely indi&iduali5ed care and the face-to-face time'ith your physician you deser&e our oFce is

considering re6ecting this go&ernment abuse of ourpatients and opting out of the Medicare program+ Optingout of Medicare means that you 'ould pay reasonablefees out of poc,et and not be able to obtainreimbursement from Medicare for the ser&ices our optedout physicians pro&ide+ 7ll other labs tests radiologicstudies and hospital care 'ould be co&ered by the


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Medicare Patient Surve01+ 1+ n &ie' of the fact that go&ernment

interference in medicine 'ill continue to

restrict our ability to pro&ide you 'ith theHuality care you deser&e 'ould you be'illing to recei&e higher Huality carepro&ided by an opted out physicianJ 7ny

CommentsJ)+ n &ie' of the fact that you are already

paying substantial Medicare deductibles andco-pays outof-poc,et for go&ernment-

rationed care 'ould you be 'illing to pay alittle more out-of-poc,et to recei&e bettercareJ ?getting in to see our physiciansooner and ha&ing more face-to-face time'ith our physician so that all of your

Huestions and concerns can be appropriately


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pending More ime 'ith Patients as an OptedOut hird-Party-


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Ris,

Of

Prosecution Prison

7nd

Ruinous


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Reco&ery 7udit Contractors ?R7Cs@

?Pri&ate Bounty !unters@

Kone Program ntegrity Contractors?KPCs@ G loo,ing for crimes


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;(ects of ObamaCare

ncreased federal sentencing guidelines by )0-"0% for crimes o&er 1 million in losses

ncreased license chec,s and site &isits for

physicians deemed to be high ris, for fraud andabuse

CM implemented ad&anced predicti&e

modeling technology to detect fraud

Pro&ided an additional 3"0 million o&er 10years to boost anti-fraud e(orts


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pending More


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LR

/efeated?7 Cause for CelebrationJ@


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mall practices li,ely to be NlosersE underM7CR7http2medicaleconomics+modernmedicine+commedical-economicsne'ss

mall-practices-li,ely-be-losers-under-macra

#CM estimates that :% of the nationEs solo practices?nearly 103000 physicians@ 'ill face a penalty in )01

the =rst year of the program to the tune of 300 million+ he ne's is eHually as pessimistic for practices of t'o tonine physicians ?an estimated 1)*000 physicians@ 'hocould see penalties to the tune of ) million.

#here are 'inners and losers Qin M7CR7 and smallerpractices are more li,ely to be the losers. 9und toldMedical ;conomics+ #t appears the proposed rule 'ouldcreate a penalty system 'here the big guys Qlargerpractices 'ill be funded by the little guys+.

mall Practices 9i,ely to be NlosersE under M7CR7 By Seith 9+ Martin

http://medicaleconomics.modernmedicine.com/medical-economics/news/small-practices-likely-be-losers-under-macrahttp://medicaleconomics.modernmedicine.com/medical-economics/news/small-practices-likely-be-losers-under-macrahttp://medicaleconomics.modernmedicine.com/medical-economics/news/small-practices-likely-be-losers-under-macrahttp://medicaleconomics.modernmedicine.com/medical-economics/news/small-practices-likely-be-losers-under-macra


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ObamaCareM7CR7 7genda

9i,e ObamaCare M7CR7 is designed to

eliminate solo physician and small grouppractices and force physicians intohospital employment andor large 7COs+

he goal is to eliminate fee-for-ser&icemedicine and replace it 'ith 7COssub6ect to go&ernment control+

Centrali5ed go&ernment control ofmedicine is the ultimate ob6ecti&e+


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A) Page Proposed Rule by CM ?


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M7CR7 G 7pril 1A )01"?Medicare 7ccess and C!P Reauthori5ation 7ct of )01"@

10A+ Reducing administrati&e burdenand other pro&isions

ection 1:0)?b@?3@ of the ocial ecurity 7ct?*) $++C+ 13"a?b@?3@@ is amendedT

?/@ 7pplicable )-year periods for e(ecti&enessof aFda&its

?1@ nde=nite continuing automaticetension of opt out election


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Physicians Can o'

Permanently Opt Out ofMedicareUUUr-.untoon8s O9ce


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7lso physicians 'hose aFda&itsare recei&ed after 8une 1A )01" no

longer ha&e to rene' pri&ateMedicare contracts e&ery t'oyears+

#ection 10A?a@ of M7CR7 indicates that &alid opt-outaFda&its signed on or after 8une 1A )01" automaticallyrene' e&ery t'o years+ herefore physicians andpractitioners that sign opt-out aFda&its on or after 8une

1A )01" 'ill no longer be reHuire to =le rene'alaFda&its or ha&e their patients sign 'ai&ers Qpri&atecontracts e&ery t'o years+.

ami,a 9yons

CM Region OFce


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:actors to ;onsider in Making OptOut ecision

:inancia! ;onsiderations21+ eed to consider the total re&enue eHuation2

Lross Re&enue G ;penses V et Re&enue

)+ eed to loo, at type of ser&ices you pro&ide patient

population and ma,e an assessment about ability to

collect

directly from your patients

3+ f you elect to stay in Medicare need to consider thecost of you and your sta( ,eeping up 'ith e&er-changing Medicare rules and regulations and thecost of =ling and handling Medicare claims W appealsrelati&e to re&enue generated

*+ f you decide to Opt Out may be helpful to =nd#niche. ser&ices if possible and need to thin, aboutho' to de&elop a mar,eting campaign to inform

patients of the bene=ts of seeing an Opted Out


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M7CR7

Ihat 'ill !appen to PhysiciansIho Remain in MedicareJ

Price Controls G P7B

7lternati&e Payment Models GCapitation on teroids

?ObamaCare 7COs G money paid to

7lternati&e Payment Models ot tondi&idual Physicians@


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Merit-Based ncenti&e Program

?Iill Replace ;!R Meaningful $se and

Physician Xuality Reporting ystem ?PXR@


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$nder Merit-Based ncenti&eProgram Physicians Iill be7ssigned a Composite Performancecore ?Minimal Re'ards@


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Non&:inancia! ;onsiderations2

1+ he freedom and pleasure of practicing medicineagain

instead of practicing bureaucracy ?Sic, the #Lorilla.out of

your ;am Room@ G happiness replaces physician

burnout

)+ Positi&e patient eperience and protecting patientpri&acy

3+ o fear of ruinous =nes or prison time for inad&ertentcoding

errors or running afoul of some obtuse Medicare la'rule

regulation ?Medicare bounty hunters G R7Cs andKPCs no

longer a 'orry@*+ impli=cation G Opt Out physicians need not use any


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n ma,ing your decision about

opting out of Medicare you shouldchec, all of your contracts andhospital byla's to insure that there

are no conicts+

f you are unsure as, an attorney

to re&ie' your contracts and anyother legal documents that may bepertinent+


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Procedure for Opting Out ofMedicare

Non&Participating ph0sicians can opt outof Medicare an0 ti/e during the 0ear- Acop0 of the opt out a9davit /ust 5eprovided to the Medicare carrier1s2 no!ater than ($ da0s after the $ da0 grace period after

+ithdra+ the opt out a9davit- 4e sure tocheck other contracts and a9!iations ou


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Participating Ph0sicians can only opt

out four times during the year+

he Medicare contractor must recei&ethe opt out aFda&it one month beforethe beginning of net calendar Huarter?8an 1 7pr 1 8ul 1 Oct 1@+

/eadlines for carrier recei&ing opt outaFda&it2 March 1st 8une 1st eptember1st and /ecember 1st+


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Opt Out Ph0sicians ProvidingServices in @rgent or /ergenc0

Situations

An Opt Out ph0sician cannot /ake a ne+contract +ith a Medicare patient in an

urgent or e/ergenc0 situation-

An Opt Out ph0sician +ho providesservices in an urgent or e/ergenc0

situation can


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;arly ermination of Opt Out• ot ha&e pre&iously opted out of Medicare

•

Must notify all Medicare carriers oftermination of opt out no later than 0 daysafter e(ecti&e date of opt out

• Must refund to each bene=ciary 'ith 'hompractitioner has pri&ately contracted allamounts collected in ecess of the Medicarelimiting charge

• Must notify all bene=ciaries 'ith 'homphysician entered into pri&ate contracts of

termination of opt out and bene=ciariesErights to ha&e claims =led on their behalf forser&ices pro&ided during opt out period

Physician is then reinstated to his prior

Medicare status as if there had been no opt out


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7ou can do+n!oad step&50&stepinstructions for Opting Out" the Opt OutA9davit" Private ;ontracts for @se +ith

Patients" Sa/p!e *etters Infor/ingPatients of 7our ecision to Opt Out" and


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Ihat 7bout !ospitali5ations 9absRadiology ests upplies and !ome!ealth CareJ

Physicians 'ho are currently in the Medicaresystem either as a participating or non-participating physician 'ho opt out ofMedicare ha&e an P and are in the P;COdatabase generally should ha&e no troubleha&ing Medicare pay for hospitali5ations labsradiology ser&ices or home health care ser&ices

ebsite to +hec to 'ee i ,hysician is in

,+'

http://www.oandp.com/pecos/

http://www.oandp.com/pecos/http://www.oandp.com/pecos/


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Medications and Referrals topecialists are Lenerally ;cludedfrom the Ordering and ReferringRule

!o'e&er Opted Out PhysiciansIho /o ot !a&e an P Cannot

Let Part / /rugs Co&ered byMedicare


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Physicians 'ho ha&e ne&er enrolled in Medicaredo not ha&e to enroll in Medicare in order toOpt Out

7lso for physicians 'ho are not enrolled inMedicare or are Opted Out and not in theP;CO database there is a special abbre&iated

enrollment form G CM :""0 G you can use toenroll in Medicare for the sole purpose ofordering and referringhttps2'''+cms+go&MedicareCM-


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f an Opt-Out pro&ider elects to order and refer ser&icesMedicare contractors must de&elop for the follo'inginformation through an additional information reHuest2

Z 7n P ?if one is not contained on the aFda&it&oluntarily@4

Z Con=rmation if an OFce of nspector Leneral ?OL@eclusion

eists ?if not contained on the 7Fda&it@4Z /ate of Birth4 and

Z ocial ecurity umber ?if not contained on the7Fda&it@+

f the abo&e information is not obtained the opt-outpro&ider 'ill not be able to order and refer ser&ices+ fthe opt-out pro&ider refuses to report the informationlisted immediately abo&e then the opt-out pro&idercannot order and refer but the failure to report this

additional information does not a(ect the pro&iderEs right


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77P also o(ers hri&e G ot 8$ur&i&e eminars a couple of times

per year at di(erent locationsthroughout the country ?77P hadbeen running these 'or,shops for 1*

years@

ee2 77Ponline+org for

Registration and Course /etails7 ta-deductible donationto our 77P ;ducational


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Tips for Opting OutB1+ tart at least A months in ad&ance of

beginning of Opt Out period+ his pro&ides

time to inform patients of changes and timefor your sta( to ad6ust+


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f You !a&e peci=c Xuestions

7bout Opting Out of Medicare or ransitioning to a hird-Party-

The 2016 Physician's Guide to Opting Out of Medicare

Documents

Transcript of The 2016 Physician's Guide to Opting Out of Medicare