can a pathologist refuse medicare?

[Arctic Char]

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i'm a resident, so you may understand why i don't know the answer to this question:

clinical docs can choose what insurance they accept. they can choose whether to accept medicare or not. if they find medicare reimbursement inadequate, they choose not to accept a patient based on that issue. so how does it work with pathology out in private practice settings? can a pathologist say "sorry, take that specimen yourself, because I don't take medicare cases" . . . why would/would not a pathologist reject a particular insurance plan?

is it just that we are at the end of the line, so are bound to our clinicians' insurance policies?

if anyone can elaborate, i'd be very interested in hearing more about this . . .

 

[pathstudent]

i'm a resident, so you may understand why i don't know the answer to this question:

clinical docs can choose what insurance they accept. they can choose whether to accept medicare or not. if they find medicare reimbursement inadequate, they choose not to accept a patient based on that issue. so how does it work with pathology out in private practice settings? can a pathologist say "sorry, take that specimen yourself, because I don't take medicare cases" . . . why would/would not a pathologist reject a particular insurance plan?

is it just that we are at the end of the line, so are bound to our clinicians' insurance policies?

if anyone can elaborate, i'd be very interested in hearing more about this . . .

You could but you would be making your life harder rather than easier. If you were a hospital based group, you would really piss off the hospital admins by not accepting medicare.

And the federal govt has a law that says that if you opt out of medicare there is a maximum you can bill/collect on geezers. i.e. if the gov't pays 40 bucks for the professional on an 88305, then the law might say you can't bill for then 45 or something like that. But what makes it a real son of a bitch is that the govt won't send you the money. They send the 45 to the patient and then you have to try to collect it from the patient. Good luck doing that, especially if you have just given the patient metastatic pancreatic cancer or something like that. The government protects geezers.

Basically if you don't want the hassle you could just send off the case to some other group or academic medical center who would gladly take it. But unless you are pumping full tilt on private cases, why not just sign it out.

 

[deleted314957]

As pathstudent said, it would make it almost impossible to have a hospital contract and damned near any other contracts. We are not like your endocrinologists office where there is a secretary/receptionist at the front window to ask lots of questions and have you fill out paper work. And a nice little sign that says payment for services is expected at the time of services,etc. As well as a computer which pulls up your past payment hx, etc.

We get a bx from Joe/Jane Blow in the O.R.---say a pulmonary wedge with no hx and we do a TP and a FS and (dammit it's a granuloma) and we get to do a bunch of special stains (and now the cryostat needs to be decontaminated). And---SUPRISE!--- this patient has no insurance and not a penny to his/her name. But we do it because we really like pathology and we are PHYSICIANS.