Coverage for Private Practice - Opted Out Medicare

[trixter888]

Hi,

I am currently a 1099 employed physician who has opted out of medicare. I work for a therapist owned organization who has also opted out of medicare. I meet with patients only once to provide them with a second opinion.

After about a year of providing services, I am now searching for a clinician to see clients while I am either gone on vacation or sick.

Is there any possibility for me to have a medicare enrolled psychiatrist cover for me?

I was reading this website which indicated in some circumstances clinicians can bill under another clinician's NPI. I have both an NPI I and II for my separate private practice (not sure if this matters). Billing Under Another Provider's Number | MagMutual

I am wondering if the medicare enrolled clinician (who would only be providing me with temporary coverage) could then see my patients? We have patient sign a form stating that I am out of network and they would not seek reimbursement from medicare. In this scenario if for some reason a patient does choose to submit to medicare, the NPI provided to the client would be mine, and thus would show that I am "opted out."

Any thoughts about this, or has any other private practice medicare opted-out physician encountered this?

Thank you!

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[Sushirolls]

Good question! Tricky one.
I am not nuanced enough to give a true authoritative answer.
I suspect you'll need to call your local MAC and ask them.

My suspicion is that the answer is no. I believe the billing under another's NPI is only in context of locums scenarios to facilitate ease of submission to insurance, when those folks haven't yet been paneled by that hospital/organization and I think it limits up to 90 days that it can be used before the locums needs/should be paneled.

I believe a doc still accepting assignment (in with medicare) simply can't charge your patients. They can see them for free...

That's why any out of network flavored medicare patients who inquire with me I simply turn away. Even if its an advantage plan I might be able to charge cash for(?), I just don't want to deal with it or risk it.