The annual game of “Chicken” on Medicare fee cuts is beginning, as AMA members and patients are urged, in expensive television ads, to beg Congress for a reprieve from the automatic “SGR” cuts. This will give Congress time to think up a new way to reduce care for Medicare patients.
It’s time to tell them to go ahead with the cuts—just let us out of their bureaucratic nightmare.
Perhaps doctors should consider disenrolling from Medicare, and challenging Congress to give a straight answer to some simple basic questions. Are Medicare patients allowed to see a disenrolled doctor and pay a mutually agreeable fee? If they do so, can they file the simple CMS form 1490S and be reimbursed?
This form has no codes, just a plain English description of the service provided. If Medicare wants a code, let the carrier’s functionaries provide it. They must know what it is, since they claim to know when the doctor gets it wrong.
If Medicare wants to use the AMA’s “relative value” setting committee (the ”RUC”) to help calculate a reimbursement schedule, let the government pay the AMA for figuring it out, instead of forcing doctors to buy codebooks from the AMA. If Medicare wants to use some other method, that’s fine too. Let CMS and its contracted private carriers face the wrath of seniors if they are too stingy.
Without all that overhead for claims filing and compliance busywork, doctors will be able to charge less but earn more. They might say, “When would you like to come in?” instead of “We’re not taking Medicare patients.”
Many physicians complain that as it is they don’t get paid enough by Medicare to meet their overhead. They’ll have to greatly restrict Medicare, even if the SGR cuts are postponed. But Congress will not get the message unless they really do quit.
Once out of the bureaucratic morass, doctors might again love seeing their patients. Patients will probably find they get better service and at a reasonable price.
Medicare Part B might seem like a good deal for seniors. But what if it’s mainly a cash cow for carriers, the AMA, purveyors of overpriced Medigap policies—and schemes for filing fraudulent claims? What if for their $1,200 or so per year in Part B premiums plus copays all seniors get is a perfunctory 5-minute visit or no appointment at all?
The way to find out is to cut, cut, cut.
Cut the fees, cut the bureaucracy, cut the interference. Let the patients and doctors who want to do so exit the system, and without forcing patients to promise to forgo benefits they have paid for, as they must in order to see an enrolled but “opted-out” doctor.
For information on private contracting and the disenrollment option, see the winter issue of the Journal of American Physicians and Surgeons.
For prices available for ambulatory surgery procedures for patients who do NOT have Medicare Part B, see www.surgerycenterok.com.
For information on how to call your congressional delegation, see http://www.contactingthecongress.org/ or call the congressional switchboard, (202)224-3121. Tell your congressman you are not asking for more money or for a 1,000-page bill. All you want is a letter to CMS and the Medicare carrier for your area https://www.cms.gov/MedicareProviderSupEnroll/downloads/contact_list.pdf, asking them to abide by current law.
The Congressman might write, for example:
Center for Medicare and Medicaid Services
7500 Security Blvd.
Baltimore, MD 21244And/Or to Medicare carrier (see link above)
To Whom It May Concern:
The law that established Medicare guaranteed that the federal government would not interfere with the right of citizens to consult the physician of their choice. It did not require that any physician had to enroll in Medicare or accept payment from Medicare.
CMS has forms for doctors to use in order to disenroll from Medicare, and Form 1490S for beneficiaries to file for reimbursement of fees paid to physicians who are voluntarily not enrolled in Medicare (i.e. who have not been excluded as a penalty). This payment goes to patients, not to physicians. It is the patient’s benefit, not the physician’s. The patient is enrolled in Part B, but the physician is not.
Please confirm that (1) you will not attempt to penalize physicians for disenrolling and continuing to serve patients who may be Medicare beneficiaries without filing a claim, and (2) you will reimburse patients who file CMS Form 1490S. Alternately, cite the statute or properly enacted regulation that you construe as justification for your policy. In particular, cite any law that requires physicians to be enrolled in Medicare, and any law that allows them to file a claim if they are not enrolled (and thus do not have billing “privileges”), and any law that denies Medicare beneficiaries the right to spend their own money for the medical care of their choice.
Sincerely, Rep. (Sen.) _____________________________________
Ask your Congressman or Senator to send you a copy of the letter, and the reply, and please copy to AAPS at 1601 N. Tucson Blvd. Suite 9, Tucson, AZ 85716.
