ashleymatias1
New
I work at a pediatric office and we have recently opened a general practice. Can we see a Medicare patient if they only have part A (we opted out of medicare and medicaid)?
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Wiki Medicare patients
- Thread starter ashleymatias1
- Start date
SharonCollachi
Guest
If a patient has Part A Medicare, that only covers hospital care, not physician care (which means your opt-out status becomes irrelevant). If they have no other coverage, you can see them as a cash pay patient.
ashleymatias1
New
Thank you, I thought so, but the provider is telling me that she can't
SharonCollachi
Guest
What is her reasoning for her response?
ashleymatias1
New
she thinks it is illegal to charge self pay rate
SharonCollachi
Guest
If you are a Medicare Part B provider that has not opted out, you cannot see a Medicare Part B patient for cash.
You are a Medicare Part B provider that has opted out.
Your patient does not have Medicare Part B.
You can see them for cash.
You are a Medicare Part B provider that has opted out.
Your patient does not have Medicare Part B.
You can see them for cash.
suki_26
Networker
Be careful with Medicaid though... You cant charge Medicaid patients cash. Especially if you know they have Medicaid.
SharonCollachi
Guest
This may be state-specific. In California, a Medicaid patient can choose to see a non-Medicaid provider for cash.
suki_26
Networker
Oh wow, I didn't realize that. Yea that is definitely a New York thing
SharonCollachi
Guest
There was another question I read earlier today where the response from NY was that it CAN be done, if the patient signs a form first, like a modified ABN.
suki_26
Networker
Thanks Sharon, Ill have to look into this more. I know if the patient has an "overage" they can be charged but I was pretty sure if they have full coverage they cant be charged. Thank you 
Yes, for Medicaid patients, if you are non-participating with all types of Medicaid including Medicaid managed care, it is possible to see patients and charge them. Here's my other post about it:Thanks Sharon, Ill have to look into this more. I know if the patient has an "overage" they can be charged but I was pretty sure if they have full coverage they cant be charged. Thank you
https://www.health.ny.gov/health_care/medicaid/program/update/2014/2014-02.htm
If you are non-par with all Medicaid and Medicaid managed care, you should inform the patient that you are out of network. The patient has the option to see you as a cash patient, or seek care from an in network provider. As advised in the link:
A provider who does not participate in Medicaid fee-for-service, but who has a contract with one or more managed care plans to serve Medicaid managed care or FHPlus members, may not bill Medicaid fee-for-service for any services. Nor may any provider bill a beneficiary for services that are covered by the beneficiary's Medicaid managed care or FHPlus contract, unless there is prior agreement with the beneficiary that they are being seen as a private pay patient as described previously. The provider must inform the beneficiary that the services may be obtained at no cost from a provider that participates in the beneficiary's managed care plan.
I suggest creating a form for the patient to sign stating this prior to any services.