2-year "probation" period for PAs to bill Medicare after working in no-insurance practice?

[ehfrost]

Hi folks,

 

I heard a disturbing comment by a fellow student the other day, and since CMS is closed and I can't call right now, thought I'd throw it to practicing professionals:

 

Q: If a PA works in a clinical practice where Medicare/Medicaid/private insurance is not taken, then said PA moves to a different job where the practice does accept these insurances, Is it TRUE or FALSE (and can you show me documenation?) that this PA cannot bill for Medicare/Medicaid services for 2 years?

 

I suspect something got lost in the translation; maybe paperwork to become a CMS-recognized provider takes awhile, but 2 years? That seems crazy to me.

 

Any thoughts are very much appreciated. I will practice in NC. I wonder if this is a specific NC rule. I'll call the NCAPA and AAPA during business hours to confirm. Or CMS, if I have hours to wait on-hold for a human being to answer my question...

 

Thanks

L

[ventana]

Ahhh

 

 

no

 

 

 

 

you should be billing medicare/medicaid for the work you do, but their is no 2 year waiting period

[Joelseff]

Yeah never heard of that.....ever...

 

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[Guest Paula]

I vaguely remember if a physician decides not to take medicare any longer and opts out, then wishes to re-inroll in it, there is a two year waiting period.  I swear this is true because a former SP of mine MD spouse opted out of medicare to start her own concierge practice and it was an agonizing decision for them to have her opt out.  

[Joelseff]

Does that apply to us? If I work at a side gig that doesn't take insurance like an UC will I not be able to bill at my practice for 2 years? :Scratches head:

 

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[ehfrost]

Scratches head:

 

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That's my reaction exactly.

[Guest Paula]

I think it is the issue of OPTING out of medicare.  Not an issue if the practice doesn't take medicare but a physician who opts out of it.  I do not know if it applies to PAs. Now I'm curious. How big is the medicare manual?....this might take days to find the answer. 

[Guest Paula]

Opting Out of Medicare - CGS

[Guest Paula]

Don't you love google????? ^^^^^   So the opting out is a two year contract and you can't opt back in until the contract is up.   Looks like it applies to physicians and practitioners......i'm assuming that means us. 

[Joelseff]

Right on Paula. Thanks.

 

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[rev ronin]

Why would you have to opt out of medicare to run a concierge practice? Simply don't accept it, make people pay up front, and be done with it.  Whether the people signing with a concierge service are covered under medicare or not is (or at least should be) irrelevant: a contract between private parties does not involve the government.

[ventana]

Why would you have to opt out of medicare to run a concierge practice? Simply don't accept it, make people pay up front, and be done with it.  Whether the people signing with a concierge service are covered under medicare or not is (or at least should be) irrelevant: a contract between private parties does not involve the government.

 

 

no can do

 

if you accept medicare you HAVE TO accept medicare, only way to do a concierge practice is to opt out... but see below...

 

 

Medicare is making it a lot harder to opt out - last I looked you HAD to be in medicare in order to order any DME......     

[rev ronin]

So what if I want to just never take or bill medicare for anything?  Why should I have to opt out?  Why would Medicare even know or care?  Is it somehow a crime to take money to provide medical services to a medicare-covered individual?

[Guest Paula]

^^^^^^ This is the sickness of government. 

[ehfrost]

Thanks y'all for your input. Many of the questions you're asking here are the ones I asked myself when this came up. I have some MD friends who own a practice that doesn't take insurance. I'm waiting for a reply from them about the "rules" as they understand them; the way the document reads that Paula found, whatever applies to them applies to all "practitioners" 

 

Oh, the federal government...

[ehfrost]

So, an update from friends who own a "Direct Primary Care" (DPC) ("concierge" to some of you) clinic in NC focusing on nutrition, lifestyle and complementary medicine, along with allopathic options:

 

"We have not fully opted out since Provider A occasionally picks up urgent care shifts. I could opt out, but like the idea of being able to pick up shifts somewhere that takes Medicare if I need to. Basically, with direct primary care, as long as you don't bill for a Medicare billable service, then all is good -- hence the alternative terms we use for an establish care visit. If we accidentally bill someone for a medicare billable service (say a blood test, procedure, etc) then we would not be Kosher. That's why we bill labs through LabCorp or Quest or whatever.

 

As direct primary care is picking up steam nationally, we likely won't have to play this silly game too much longer. DPC saves the entire system, including medicare buckets of $$, so eventually it will not be so difficult for us."

 

So, it sounds like you don't have to opt out completely to still be Kosher, so long as the services you provide to a Medicare patient could not be provided elsewhere and covered by Medicare.