medicaid/medicare enrollment as resident

[brodaiga]

Doing some weekend moonlighting while in residency. Place is suggesting they enroll me in medicaid/medicare. I am not sure if I want this. Plan on doing locums when I graduate. Any downsides/upsides to not doing so? I don't want some kind of obligation in the future because I enrolled. Thanks

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[brodaiga]

Doing some weekend moonlighting while in residency. Place is suggesting they enroll me in medicaid/medicare. I am not sure if I want this. Plan on doing locums when I graduate. Any downsides/upsides to not doing so? I don't want some kind of obligation in the future because I enrolled. Thanks

anyone?

 

[michaelrack]

As someone who just completed a locums assignment, I can tell you that you need to be enrolled in Medicare (have an NPI #). Whether to opt out of medicare (not accept their fee rate) in the future is another issue- but usually it is not a good idea to opt out- just don't accept many/any medicare pts into your future practice if you don't want to

 

[notdeadyet]

As someone who just completed a locums assignment, I can tell you that you need to be enrolled in Medicare (have an NPI #). Whether to opt out of medicare (not accept their fee rate) in the future is another issue- but usually it is not a good idea to opt out- just don't accept many/any medicare pts into your future practice if you don't want to

Agree with this. I'd also strongly advise to request your first locums gig to apply for your Medi/Medi on your behalf. An admin can probably whip through it quickly, but when I looked over the actual application it would have taken me hours to go through.

 

[ferning]

Cant they run your billing through their own npi?

 

[michaelrack]

Cant they run your billing through their own npi?

I am not sure, but they can't do even do that (bill for your services) if you don't have an NPI.

 

[brodaiga]

As someone who just completed a locums assignment, I can tell you that you need to be enrolled in Medicare (have an NPI #). Whether to opt out of medicare (not accept their fee rate) in the future is another issue- but usually it is not a good idea to opt out- just don't accept many/any medicare pts into your future practice if you don't want to

I already have an NPI. I guess I will have them apply for medicare/medicaid for me. Why are some psychiatrists opting out of applying if they don't have to accept those patients once enrolled?

 

[PikminOC]

Are you sure you aren't already enrolled by your residency program?

 

[Doctor Bagel]

Are you sure you aren't already enrolled by your residency program?

Yeah, we had to enroll.

 

[PikminOC]

Yeah, we had to enroll.

So then what's the issue for the OP?

 

[swisschard]

Opting out is a fine idea if you're only in private practice, but if you're doing any contract work or locums work, you'll likely need to be able to bill medicare as a condition of employment there.

 

[MacDonaldTriad]

If you are still a resident and CMS is paying your wages, your billing Medicare would be double dipping. Residents are not allowed to bill Medicare for outpatient work, they can see them, but CMS feels like they have already paid you to see them. I'm not sure if moonlighting is an exception or not.

 

[splik]

If you are still a resident and CMS is paying your wages, your billing Medicare would be double dipping. Residents are not allowed to bill Medicare for outpatient work, they can see them, but CMS feels like they have already paid you to see them. I'm not sure if moonlighting is an exception or not.

Residents can't bill for services at any sites affiliated with their hospital GME system (i.e. internal moonlighting) but they can for external moonlighting. This is covered in 42 CFR 415.208 - typically the GME office will have to approve moonlighting to make sure this isn't an issue, but in practice only large unwieldy monoliths (like UPMC) where this gets confusing as the resident may not realize a particular clinic or hospital is actually part of their institution and internal moonlighting includes any affiliates regardless of if you ever rotate their as a resident per the law.

 

[finalpsychyear]

If you are still a resident and CMS is paying your wages, your billing Medicare would be double dipping. Residents are not allowed to bill Medicare for outpatient work, they can see them, but CMS feels like they have already paid you to see them. I'm not sure if moonlighting is an exception or not.

Out of curiosity, when you have an NPI number as a resident and have finished your residency. Whether you move states or stay locally are you technically still enrolled in medicare by default?

 

[splik]

an NPI number is necessary but not sufficient to be enrolled in medicare. unless you never plan on having anything to do with insurance (including patients who use insurance to pay for prescriptions you need an NPI number). I have an NPI number but am not enrolled in medicare (which you do through PECOS - its a different system to getting an NPI). also important to bear in mind that medicare has an opt-out system.

 

[notdeadyet]

Residents can't bill for services at any sites affiliated with their hospital GME system (i.e. internal moonlighting) but they can for external moonlighting.

That's interesting. I wasn't aware of that.

Then why is it that some programs get all residents registered for medicare during residency? I know mine did.

 

[swisschard]

Out of curiosity, when you have an NPI number as a resident and have finished your residency. Whether you move states or stay locally are you technically still enrolled in medicare by default?

Yes, you remain enrolled from what I understand.

 

[trophyhusband]

That's interesting. I wasn't aware of that.

Then why is it that some programs get all residents registered for medicare during residency? I know mine did.

Well as of 2016 residents/fellows need to be enrolled to prescribe to patients with Part D. I don't really know why they did it before 2016 though. There are certain primary care and psychiatry residencies (or rotations) where they can bill on your behalf outside of the IME and DME payments but I wouldn't think every residency has these types of situations. I wonder if they need your enrollment to shadow bill for IME and DME claims billed to Medicare Advantage plans or if it's required to get the IME and DME payments through their cost report.

Sorry, don't know if you really wanted an answer or not but I always wondered why they did it when my wife started residency as well.

 

[Extralong]

Doing some weekend moonlighting while in residency. Place is suggesting they enroll me in medicaid/medicare. I am not sure if I want this. Plan on doing locums when I graduate. Any downsides/upsides to not doing so? I don't want some kind of obligation in the future because I enrolled. Thanks

Legally by this Summer(I think June) all residents/fellows have to be enrolled. If you do not moonlight, it'll likely be 855O, but if you do moonlight, it can be 855I. There is a way around this, but its super complicated and the GME program has to be on board with this.

Here is the CMS FAQ website:
https://www.cms.gov/Medicare/Provid...ProviderSupEnroll/Downloads/CMS-4159_FAQs.pdf

Look at question number 8:
"8. I am currently a resident, intern or fellow. Am I required to enroll or optout?
Interns, residents and fellows who are authorized by state law to prescribe drugs (inparticular Part D drugs) and who are in an accredited graduate medical education program thathas opted to allow them to prescribe Part D drugs, must be enrolled in Medicare to prescribe Part D drugs. If the accredited graduate medical education program has opted to require the signature of the teaching physician on all prescriptions for Part D drugs, then the intern, residentor fellow, need not be enrolled. The person who is prescribing the drugs—whose name andNPI appear on the PDE—must be enrolled or validly opted out. State licensed interns, residents, and fellows - who prescribe Part D drugs – must be enrolled in Medicare to prescribe. Licensure can include a provisional license or similarly- regulated credential. Licensed residents have the option to apply to enroll, opt out, or use the teaching physician on claims. Un-licensed interns, residents, and fellows must use the teaching physician’s name and NPI on the prescription."

Hope that helps!