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Locum tenens

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neopsych12

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I am looking to do some locums work as I build my private practice. I do not plan on accepting medicare in my private practice. If I become a Medicare provider for my locum position, will I have to accept Medicare in my PP as well?
 

neopsych12

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I am asking if I can charge Medicare patients my regular rate, which is higher than what Medicare pays.


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nexus73

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Just try to avoid Medicare in your pp
 

Shikima

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You do not have to accept Medicare in your PP. It's a separate entity you're working at compared to General Hospital where you'll be rounding.
 

PsyDr

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You have to opt out of medicare. This is a letter that is specifically worded and has to be redone every 2 years. It does not matter if your PP is a separate entity.
 

PistolPete

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You have to opt out of medicare. This is a letter that is specifically worded and has to be redone every 2 years. It does not matter if your PP is a separate entity.

I believe you no longer have to opt out every 2 years, due to new rules. Once is enough. My understanding is that for your private practice, you could still see Medicare patients and charge them more than what Medicare allows, it's just that those patients have to sign a form stating that they will be on the hook for your fee and cannot bill Medicare for the visit for any reimbursement. Check out sample opt-out forms here:

http://aapsonline.org/sample-medicare-opt-out-forms-2/
 

PsyDr

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I believe you no longer have to opt out every 2 years, due to new rules. Once is enough. My understanding is that for your private practice, you could still see Medicare patients and charge them more than what Medicare allows, it's just that those patients have to sign a form stating that they will be on the hook for your fee and cannot bill Medicare for the visit for any reimbursement. Check out sample opt-out forms here:

http://aapsonline.org/sample-medicare-opt-out-forms-2/


Huh. Any effect on part D payment of scripts written by an opt out person on this new regulation? I heard of some problems, although I admittedly wasn't paying attention in that conference.
 

PistolPete

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Huh. Any effect on part D payment of scripts written by an opt out person on this new regulation? I heard of some problems, although I admittedly wasn't paying attention in that conference.

My understanding is that no, but I will admit I'm not an expert in this area. My understanding is that medications can still be covered under Medicare Part D, but that the physician and facility fees would not be, for a physician who has opted out of Medicare.
 
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I don't believe you can opt out for one practice location but not another. If you are opted-out then your locums site can't bill Medicare in your name. If you are opted-in you are not allowed to charge more than the Medicare rate in your private practice.

"Can a physician or practitioner "opt out" for some Carrier jurisdictions but not others? No. The opt out applies to all items or services the physician or practitioner furnishes to Medicare beneficiaries, regardless of the location where such items or services are furnished."
https://www.sanctionscreeningnow.com/opt-out_faq.html

"“[W]hen a group physician has opted out, it does not affect the ability of the rest of the group members to furnish and bill for services they furnish to Medicare beneficiaries…. [H]owever, … when a group physician has opted out, the group may not bill in its own name for services provided by the opt-out physician under a private contract….” (66 FR 856, 1/4/01)."
http://aapsonline.org/notes-on-opting-out-of-medicare/

The best approach is just not to take Medicare patients in your private practice at all. Taking them and charging them more than the Medicare rate while you are simultaneously contracted with Medicare elsewhere is a big no-no.
 

PistolPete

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I don't believe you can opt out for one practice location but not another. If you are opted-out then your locums agency can't bill Medicare in your name. If you are opted-in you are not allowed to charge more than the Medicare rate in your private practice.

"Can a physician or practitioner "opt out" for some Carrier jurisdictions but not others? No. The opt out applies to all items or services the physician or practitioner furnishes to Medicare beneficiaries, regardless of the location where such items or services are furnished."
https://www.sanctionscreeningnow.com/opt-out_faq.html

"“[W]hen a group physician has opted out, it does not affect the ability of the rest of the group members to furnish and bill for services they furnish to Medicare beneficiaries…. [H]owever, … when a group physician has opted out, the group may not bill in its own name for services provided by the opt-out physician under a private contract….” (66 FR 856, 1/4/01)."
http://aapsonline.org/notes-on-opting-out-of-medicare/

The best approach is just not to take Medicare patients in your private practice at all. Taking them and charging them more than the Medicare rate while you are simultaneously contracted with Medicare elsewhere is a big no-no.

I stand corrected. I guess if you take Medicare at an employed position you'd have to also take it at a private practice office. All in or all out.
 
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