Practice Management Alert

With yearly -- and now twice yearly -- threats of huge cuts to Medicare payments, your practice may be starting to wrestle with the solution of opting out of Medicare altogether. How can you determine whether the benefits of opting out outweigh the costs? How do you even go about opting out? Follow these expert tips to ensure you-re choosing wisely.

Before you pursue opting out of Medicare, take a look at what rewards you-ll reap for doing so. One benefit would be not having to worry so much about looming fee schedule cuts from CMS every six months to a year.

"Of course some of the benefits would be better payers and higher revenue," says Deb Flanagan, recovery unit manager for Inland Cardiology Associates in Spokane, Wash. You wouldn't have as many "hoops to jump through" as "Medicare seems to be making it more and more difficult on physicians to even see Medicare patients."

Specialists are more likely to opt out than general practitioners because specialists often see more self-pay or privately insured patients. Opting out can actually make providing complete care to patients easier for some physicians. Some physicians commonly have to provide services Medicare does not cover, which leads to patients paying the bills themselves. If some of your Medicare patients have to pay for portions of their care anyway, you may find dropping Medicare easier.

Important: You can still see Medicare patients in your practice even if you opt out of Medicare, says Marge McQuade, CMSCS, CMM, a consultant and small medical billing service manager in Florida. You have to have a private contract with any Medicare Part B beneficiary before treating him. You will be able to treat patients with Medicare coverage just like before, but you won't bill Medicare for the services. Instead, you will bill any secondary or supplementary insurance the patient may have, or bill the patient directly.

Keep in mind: When you bill the patient's secondary payer, you may not get paid if you don't contract with Medicare. Some insurances, such as Medigap, only pay if Medicare pays.

Bonus: Because you will no longer be subject to any of Medicare's billing rules and regulations if you opt out, you may even be able to offer a discount from your standard fees to a Medicare patient who has financial need and is self-paying. Depending on the circumstances, you may be able to offer the patient a discounted price and still charge more than Medicare would pay you.

If your practice does opt out of Medicare, you may suffer some ill effects with the positives. By opting out, you may lose a portion of your patient base. You need to evaluate your patient base and your financial plan to deter-mine exactly how opting out will affect your bottom line.

How: Analyze your Medicare patients, the other insurers you contract with, and the type of care you-re providing. Watch out for Medicare patients who may have secondary or supplemental insurance with a provision that guarantees coverage only if your practice bills Medicare first. Ensure that you will still be able to receive payments from secondary or supplemental insurances by checking first to see if your carriers have certain filing requirements for providers who don't contract with Medicare.