How do you fare with Medicare?

June 23, 2010

With Medicare reimbursement cuts looming, many physicians are considering opting out of Medicare. And it’s not just payment rates that have doctors dropping out: those who participate in Medicare are struggling to cut through the red tape just to keep their coverage active.

With Medicare reimbursement cuts looming, many physicians are considering opting out of Medicare (if they haven’t already). And it’s not just payment rates that have doctors dropping out: those who participate in Medicare are struggling to cut through the red tape just to keep their coverage active. We received a comment from a psychiatrist regarding his experience trying to hold on to his Medicare participation status. We invite you to share your views and experiences on this controversial issue.


In early December 2009, I received a letter from Highmark Medicare Services, a Medicare contractor with CMS, regarding “reporting responsibilities,” stating that if I had no changes in my practice, “no action on your part is required.” Then in early January, 2010, I received another letter, which was a bit difficult to understand, but was somewhat threatening, asking for some new enrollment application that had to be submitted within 60 days of the postmark.


I happened to be out of town when the second letter arrived, and because the first letter said no action was necessary, I unfortunately neglected to take any further action on the second letter. Late in April, I received another letter titled: Notice of Revocation of Medicare Billing Privileges. This was very upsetting.


I tried to comply with all of the numerous requirements suggested as part of an appeal, including sending in a 42 page reenrollment application (which actually had no new information that they didn’t already have) but was notified that I could not call and inquire about the status of my “re enrollment” and could only access a website that only gives the information that the “application is received.”


I believe in the medicare system and in government sponsored health care. I don't have a large number of medicare patients, and provide for them mainly as a courtesy, since Medicare pays about one-half to two-thirds of the local therapy rate. But the tone and the attitude of this experience has been very disquieting.


In addition, I can no longer use the electronic system to bill for patients I saw before my privileges were revoked. And I cannot provide Medicare services to my old (or new) patients, which is a hardship on some of them, who are not that financially comfortable.

--- Fearfulshrink