Medicare patients when employed with side practice

[SteinUmStein]

Happy Wednesday,

I've been reading on this topic and am still somewhat lost. Let's say you are a physician employed by a group practice that sees a mix of patients, including patients with Medicare, and you accept Medicare at this group practice location. If you have a private cash-only practice on the side at a separate location, potentially including telepsych cash-only practice, would you need to notify all patients ahead of time that you aren't able to see Medicare patients? Would they need to sign something saying they don't have or won't submit claims to Medicare? I'm not to the point where I'm doing any of this, but don't want to anger the CMS gods down the road. My understanding is that you are "all in" or "all out" on Medicare, just want to make sure being employed at a group practice doesn't make private side cash-only practice impossible.

Thanks!

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[TexasPhysician]

It gets quite tricky. The cash practice would have to ensure no Medicare patients are accepted. If one is seen and complains, you will likely need to refund 100% of everything you collected from them.

 

[finalpsychyear]

It gets quite tricky. The cash practice would have to ensure no Medicare patients are accepted. If one is seen and complains, you will likely need to refund 100% of everything you collected from them.

So im clear on the matter. If i have a private practice that excepts all insurance except insurance X. Then I decide to work at a psych hospital where i do my own billing and i need to be able to see insurance x as in network, I am able to get credentialied only at that location under insurance x and would continue to be considered out of network at my private practice for insurance x?

 

[thoffen]

Medicare is opt-out or you're a Medicare provider. Other insurances are contracted in a narrower scope, so being in network with them at one practice doesn't mean anything for another.

I've seen the issue as it pertains to Medicare discussed here a few times and never was satisfied with the answer. But I think that it would be a big screw up to have a Medicare patient paying you cash then bring to you that you need to be billing Medicare instead during treatment. That should absolutely be clear before starting a treatment relationship. If a patient agrees to it, though, then screws you over by lying about their Medicare status or expectation of financial arrangement, you're probably screwed anyway.

 

[TexasPhysician]

So im clear on the matter. If i have a private practice that excepts all insurance except insurance X. Then I decide to work at a psych hospital where i do my own billing and i need to be able to see insurance x as in network, I am able to get credentialied only at that location under insurance x and would continue to be considered out of network at my private practice for insurance x?

Medicare and Medicaid are special. Either in or out.

Commercial insurance is location specific.

 

[SteinUmStein]

Thanks for the input, that's what I thought. Frustrating from the physician standpoint - preaching to the choir here, but I can easily see situations where the physician/psychiatrist is doing their due diligence and respecting the rules and still gets in trouble (forgetful or dishonest patients, changeover in insurance without notification, patient misunderstanding, etc etc). Anyone who is doing this kind of private side practice now, or in the past, have any input or standardized language they use to try to stay out of trouble? Big bold print on your website, handout to every new patient, signing more forms?

The easy/safe road is of course opting out of Medicare completely, which is sad, as everyone is complaining their Medicaid/Medicare patients/family members can't get in to see a psychiatrist in any kind of reasonable time period.

 

[TexasPhysician]

I opted-out.

 

[dl2dp2]

I opted out. What's weird is that in the past when I credentialed with a facility for moonlighting, this was undetected. I suspect the billing department uses a separate provider code to bill the Medicare patients if the regular one doesn't work. The credentialing department is not savvy enough to check. Whether Medicare detected this later on and just never reimbursed the notes I've signed is unclear. I'm sure nobody in the hospital cared either, since it's such small potatoes in terms of revenue stream.

I suspect if they really want you, even for a full time job, they would not care. They'll just either have someone else co-sign or do the more shady business of using a single billing ID that works for everyone. In effect this is saying that Dr. X (medical director with that ID) saw these Medicare patients in a supervisory role even though in reality he didn't. Unclear what is the nuance of compliance with Medicare is, especially in an inpatient/moonlighting context, but I know for sure this happens at multiple places.

In particular, there was one place where I was staffed as a trainee, and this place bills Medicare. However, I was NOT EVEN ON STAFF to work at that facility (I'm a trainee at a different facility, and just a visitor). The place very patently exploited me and treated me as the signing attending. I had private medmal at the time, but presumably it didn't cover this work. The credentialing office simply ascertained that I have a license to practice. I reluctantly used my personal prescription pad as I had no choice, but I have a feeling situations of this type occurs constantly, and when they get detected two things happen: the institution's director gets fired, and the institute gets shut down or restructure. However, if it's a critical clinic (and the one I worked at was pretty damn critical, since if it shut down god knows how many X Y Z with SMI and SUD will be left with no one), perhaps someone will figure out a way to "make the system whole" and bring some money from somewhere else and refund the feds. Fraud/criminal charges were rarely filed unless it can be demonstrated that a particular someone was INTENTIONALLY defrauding to PERSONALLY benefit, which is a tall order.

 

[PistolPete]

I’ll be opting out once I start my PP this summer