Ophthalmology and Optometry Coding Alert

Analyze your patient base to see how opting out will affect your bottom line

If your practice wrestles with the possibility of opting out of Medicare and you're apprehensive about the outcome, you're not alone. We have compiled the five most-pressing questions billers ask when weighing the benefits of opting out. Allow our expert answers to aid your decision. 1. Question: How will our practice benefit from opting out? Answer: "The purpose of opting out is to get rid of the middle man and make the fair profit you're supposed to," says Quin Buechner, MS, MDiv, CPC, president of ProActive Consultants in Cumberland, Wis. If you've been collecting inadequate reimbursement on a portion of your services and procedures, it may make more sense to opt out and bill what you deserve.

And, opting out can actually make it easier for some physicians to provide complete care to their patients. If a physician's patient base requires certain treatments that Medicare doesn't cover, both the provider and patient might grow increasingly frustrated. And often Medicare patients find themselves having to foot the bill for aspects of their care, says Wayne J. Miller, attorney with Compliance Law Group in Los Angeles. If some of your Medicare patients have to pay for portions of their care anyway, you may as well opt out and avoid the regulatory hassles of Medicare participation, he adds. 2. Question: What should we do first if we're considering opting out? Answer: First you need to evaluate your patient base and your financial plan to determine exactly how opting out will affect your bottom line, Buechner says. You should analyze your Medicare patients' other insurers, the type of care you're providing, and whether Medicare offers adequate coverage for rendered services, Miller says.

Seek legal counsel to help you develop the necessary documents to opt out, experts say. Some Medicare patients may have secondary or supplemental insurance with a provision that guarantees coverage only if your practice bills Medicare first, Miller says.

If you're concerned about still being able to provide care to some of your Medicare patients, you should make sure opting out won't disqualify some patients from other insurance coverage in your practice, he adds. And ensure 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 that don't participate with Medicare.

3. Question: Which practices will most likely benefit by opting out of Medicare? Answer: Specialists are more likely to opt out than general practitioners because they often see more self-pay or privately insured patients. This can make participation with Medicare not worth the billing hassles and the lower reimbursement rates. However, every [...]