Wiki Medicare patient Self-Pay

[Gator]

If a clinic is participating with Medicare but, is NOT accepting any new Medicare patients can the patient elect to still receive services on a self-pay cash basis? Limiting Charge would apply. With a waiver/ABN obtained prior to services, according to Federal Register Final Rule I would think, yes. The Final Rule states - "However, there is an exception to this rule where a beneficiary (or the beneficiary’s legal representative) refuses, of his/her own free will, to authorize the submission of a bill to Medicare. In such cases, a Medicare provider is not required to submit a claim to Medicare for the covered service and may accept an out of pocket payment for the service from the beneficiary. The limits on what the provider may collect from the beneficiary continue to apply to charges for the covered service, notwithstanding the absence of a claim to Medicare."

 

[sls314]

If a clinic is participating with Medicare but, is NOT accepting any new Medicare patients can the patient elect to still receive services on a self-pay cash basis? Limiting Charge would apply. With a waiver/ABN obtained prior to services, according to Federal Register Final Rule I would think, yes. The Final Rule states - "However, there is an exception to this rule where a beneficiary (or the beneficiary’s legal representative) refuses, of his/her own free will, to authorize the submission of a bill to Medicare. In such cases, a Medicare provider is not required to submit a claim to Medicare for the covered service and may accept an out of pocket payment for the service from the beneficiary. The limits on what the provider may collect from the beneficiary continue to apply to charges for the covered service, notwithstanding the absence of a claim to Medicare."

One key phrase in your quote is that the beneficiary "refuses of his/her own free will to authorize submission of a bill to Medicare."

That's not what is happening here. Your practice has decided not to accept new Medicare patients. The patient isn't saying, "Don't submit a claim to Medicare." You're saying, "We won't submit a claim to Medicare."