Billing medicare/medicaid without board certification?

[B52slinger]

Currently PGY-4; I have been given approval by my PD to start a PP. My remaining months of training will be easy electives of about 20 hours/week freeing up to 60 hours to do PP by ACGME duty hour rules.

I was wondering since I am neither board certified nor eligible, whether I could bill medicare/medicaid and get a head start on PP (which I plan to do long term)?

Thanks!

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[AcronymAllergy]

Not a physician, so this is just based on a quick search and I'll ultimately defer to the folks here more knowledgeable than myself: I don't think you have to be board-certified as a physician for either Medicare or FL Medicaid, but you do have to enroll with both as a provider to be able to bill.

 

[Sushirolls]

If you are starting PP now, then you either are looking to drop anchor there, or to have an exit plan to hand off the patients? If handing off, the short duration as a PGYIV won't be worth the time it takes or headache to enroll in either.

Not 100% sure, I think you can. May as well give it a try since you already have made the decision to get it going.

Just be sure to save your logins, ID, assigned numbers, letters they mail you, everything to some sort of drive or folder. Save your medicare application, too after you submit it. You'll need it to reference in the future if you ever move states.

 

[ObsequiousAplomb]

In FL there are great markets for people willing to pay cash, even those with medicare. By enrolling with medicare you forfeit that group of potential patients. Plenty of seniors want to be seen NOW and not in 3 months and have enough cash to make that happen. It's part of why it's impossible to get any house renovations in FL right now - all the rich seniors are paying through the nose to the extent that contractors exclusively target them.

 

[B52slinger]

If you are starting PP now, then you either are looking to drop anchor there, or to have an exit plan to hand off the patients? If handing off, the short duration as a PGYIV won't be worth the time it takes or headache to enroll in either.

Not 100% sure, I think you can. May as well give it a try since you already have made the decision to get it going.

Just be sure to save your logins, ID, assigned numbers, letters they mail you, everything to some sort of drive or folder. Save your medicare application, too after you submit it. You'll need it to reference in the future if you ever move states.

Yes I am planning to stay in this area long-term. The only reason I would move is if PP doesn't work out due to market forces here, which is why I want to dip my feet in ASAP. Ideally I would have a solid patient panel by the time I graduate in a few months but plan to fill in any gaps with moonlighting.

 

[B52slinger]

In FL there are great markets for people willing to pay cash, even those with medicare. By enrolling with medicare you forfeit that group of potential patients. Plenty of seniors want to be seen NOW and not in 3 months and have enough cash to make that happen. It's part of why it's impossible to get any house renovations in FL right now - all the rich seniors are paying through the nose to the extent that contractors exclusively target them.

How does the medicare/medicaid market compare to the cash market in terms of volume/filling?

Maybe this is just my lack of experience but I have heard that there is higher pressure to prescribe controlled substances under the cash-only model and would like to avoid such liability early on in my career.

 

[ObsequiousAplomb]

How does the medicare/medicaid market compare to the cash market in terms of volume/filling?

Depends where in FL you are marketing yourself. Since you're moonlighting a slow fill isn't the worst thing that could happen to you.

 

[FlowRate]

How does the medicare/medicaid market compare to the cash market in terms of volume/filling?

Maybe this is just my lack of experience but I have heard that there is higher pressure to prescribe controlled substances under the cash-only model and would like to avoid such liability early on in my career.

Taking medicaid is a great way to get pressure from patients likely already on controlled substances. Less of an issues with medicare.

But really, patients will pressure you for what they want, regardless of payor. It's up to you to choose whether you're going to build word of mouth as the candy man or as an expert clinician who provides solid psychiatric care.

Also, if your state has a high prevalence of high deductible plans, you get patients who are paying out of pocket and feel entitled similar to cash pay patients but with the hassle and limitations of taking insurance and insurance level reimbursement.

 

[Sushirolls]

^that