Valentine’s Day Could Be Medicare Freedom Day for Doctors and Patients

The Centers for Medicare and Medicaid Services (CMS) has announced the unprecedented step of allowing doctors until Feb 14 to drop their Medicare participation agreement and become a “non-participating” physician. Usually, doctors have to make that change before the end of a calendar year.

The reason is that Congress gave only a two-month reprieve from a scheduled fee cut of nearly 30%, and no one knows what will happen at the end of that period on March 1. Since physicians’ expenses run at least 50% of revenue, and often much more, doctor’s pretax income from attending Medicare beneficiaries could be cut by 60% or more.

“Non-participating” physicians may bill patients up to 115% of the Medicare-approved charge, although Medicare reimburses patients of such physicians only 95% as much as it would if they saw a participating physician. The AMA and others are providing calculators to help physicians figure out whether they can make more money by going “non-par.”

“But it’s not about the money. Non-par doctors may actually collect less,” states Jane Orient, M.D., executive director of the Association of American Physicians and Surgeons (AAPS). “The main reason to take advantage of the extended deadline is that non-par physicians are free to opt out of Medicare at any time, instead of only four times a year, at the beginning of a quarter.”

Thousands of physicians have opted out of Medicare so that they can see to their patients without the Byzantine, increasingly costly and punitive Medicare rules.

If physicians become non-par between Jan 1 and Feb 14, their new status is retroactive to Jan 1. This could create much confusion and administrative hassle if they file claims as participating physicians for any services rendered after Jan 1. AAPS suggests holding claims until the physician’s status is clear. Also, it is impossible to be sure the claim is for the proper amount when even CMS doesn’t know what the allowed fee will be.

AAPS urges physicians to obtain confirmation from their carrier if they change to non-par or opted-out status. Carriers have been known to lose documentation, and force physicians to do enormous amounts of work to refund payments and re-file claims.

AAPS offers extensive information on how to opt out of Medicare, including a list of Medicare carriers. It also provides links to carriers’ lists of opted-out physicians, for patients who prefer a private physician or who can’t find a participating physician who is willing to accept a new Medicare patient, as well as a list of its own members who are opted out of Medicare and are willing to privately contract with Medicare eligible patients.

“Opting out may be the only way a physician can keep his office open, and still be able to serve Medicare-eligible beneficiaries,” states Dr. Orient. “Without the crushing Medicare compliance costs, physicians can offer personalized, excellent care at a very reasonable price.”

AAPS, a national organization of physicians in all specialties, was founded in 1943 to preserve and promote the practice of private medicine and the sanctity of the patient-physician relationship.

Action Alert
CMS Extends Deadline To Change Participation Status
Additional Opportunity for physicians to Opt-Out of Medicare

Due to the uncertainty caused by Congress once again waiting until the last moment to delay SGR payment cuts, CMS recently extended the annual physician Medicare participation enrollment period to February 14, 2012. CMS has advised contractors to process any elections or withdrawals from Medicare during the extended enrollment period, making the effective date retroactive to January 1, 2012.

This means that physicians who currently have a participating status (PAR) in Medicare have until Feb14, 2012 to change their status to non-participating (non-PAR). This is done by writing to the Medicare contractor(s) the physician deals with, and requesting the change in status. As long as the letter is post-marked by Feb 14th, 2012, carriers have been instructed to process the request for change in status.

It is highly recommended that the physician request and obtain written confirmation from the Medicare contractor that the change in Medicare status has been properly completed. In order to avoid billing confusion, it is recommended that the participating physician switching to non-par status hold off billing Medicare until after the change in status has been confirmed by the Medicare contractor.

A list of Medicare carriers by state can be found at

Once the physician has attained non-par status in Medicare, the physician can then opt out any time by providing an opt out affidavit to the Medicare contractor(s) no later than 10 days after the first private contract is entered into. More details about how to opt-out are available at

Thus, instead of having to wait until March 1st to opt out, Medicare participating physicians can choose to opt out now. This is a unique opportunity for participating physicians.

Medicare's rules regarding the Opting Out can be reviewed at starting at the bottom of page 22 - Section 40.

While a simple process, when opting out we advise consulting your carrier and attorney to be certain you are completing the process properly to avoid fines or requests for repayment from Medicare.