Medicare in private practice; do you accept it or not?

[Ligament]

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For those of you in private practice only; do you accept Medicare or not? Why? I am rethinking my position (currently opted out).

 

[smarterchild]

I accept it for a few reasons. In my area, I have many patients who have Medicare as their primary so I would be losing a lot of patients if I wasn’t participating

also, Medicare pays for pretty much everything without any prior auth. It’s a fairly straightforward insurance. Don’t need to worry about referrals or PA, co pays, deductibles...all that stuff about private insurance that often leads to some headaches for usually not too much more money.

 

[10KHertz]

How can you fill your mornings without wonderful Medicare patients?

plus they need you .

 

[Ligament]

I do indeed love Medicare patients. Don't love Medicare.

 

[Cholula]

I accept Medicare and am exempt from MIPS due to my low volume of Medicare patients. That makes it very easy for me. I would suggest looking into if you would need to do MIPS and the reporting requirements of it. That may factor into your decision.

 

[Ligament]

I accept Medicare and am exempt from MIPS due to my low volume of Medicare patients. That makes it very easy for me. I would suggest looking into if you would need to do MIPS and the reporting requirements of it. That may factor into your decision.

Thank you. Do you recall what the MIPS exclusion criteria are, roughly?

 

[smarterchild]

How MIPS Eligibility is Determined - QPP

This page describes how your MIPS eligibility status is determined. To view your eligibility status, use the QPP Participation Status Tool. You can also learn more about your reporting options and how other reporting factors might impact your requirements.

qpp.cms.gov

the low volume criteria are towards the middle of the page.

 

[smarterchild]

Just of curiosity, for those of you who don’t accept Medicare, what are your reasons or troubles you’ve run into that led you not to take it? I myself have been in practice for only a few years but curious to hear from the more seasoned docs.

 

[drusso]

I accept it but it is so onerous on the management side. The Meaningless-Use hoops have cost us $60K per MD

 

[lonelobo]

not taking medicare is silly.....it is our demographic for chronic pain and is easiest to work with( payment ,prior auth)
I think if you can afford to not take medicare in private practice, you probably should not be bitching about the down fall of medicine like some here do

 

[bronx43]

Medicare advantage is a game changer for the worse. It pays terribly and functions like private insurer. In my area, it’s 40-50% market penetration and only increasing nationally.
I’m not pain but take both kinds of Medicare. I am considering dropping M advantage.

 

[Ferrismonk]

I take Medicare and Medicaid in private practice. Medicare I don't ever worry about, it's the Medicaid that makes my hair grey.

 

[hyperalgesia]

I am out of private practice as of 3 months ago but I accepted Medicare and Medicare Advantage. I had a pretty specific geriatric pain practice - how I marketed myself.

Medicare was good because there were no pre-auths in my area. I don't like collecting the 20% copay/deductible. Also, there's just an added layer of stress because anything you document wrong could be a federal crime - HIPAA/HITEC, etc. Medicare Advantage plans had no copay but lots of pre-auth to deal with.

Keep in mind Medicare Advantage plans don't count toward the MIPS low volume threshold so you could theoretically just keep your volume of Part B pts below the threshold to remain exempt.