Posted by: notdeaddinosaur | June 18, 2010

Playing Chicken with Medicare

Apparently the Medicare cut finally went through. As in For Real. As in Not Going to Be Fixed again. So my next check from Medicare really is going to be 20% smaller than the last one? Really?

Some may ask why I put up with this crap. Month after month, being dangled over the precipice, only to be yanked back at the last minute; even this time I’m not sure how “final” a decision this may be. It’s not an unreasonable question. Why don’t I just stop participating with Medicare and go my merry way?

The problem is that once I opt out of Medicare, I can’t reverse that decision for a minimum of two years. That’s a long time, especially when Congress could theoretically pass another midnight fix at any time that postpones the cut for another two weeks. Furthermore, even if I don’t participate with Medicare, Medicare still places statutory limits on what I can charge patients — or risk jail time. I can’t even order tests or prescribe medicines for Medicare patients. I’d better be damn careful trying to help one cross the street!

How long do I tolerate the uncertainty, not to mention an actual diminished check or two, when threats to drop Medicare produce a situation so draconian that actually doing it would essentially be cutting off my nose to spite my face.

Congress is playing a gigantic game of chicken with me and every other American physician, and I resent it.


  1. I think you are confusing non-par status with opting out. If you opt out you can charge what you want and collect all of it.

  2. Why would you not be able to see Medicare patients? I thought opt-out meant the patient would pay you directly?

  3. Wrong, Wrong, Wrong Dino:
    1. You have to notify the “powers that be” every two years if you want to remain “opted out.” If you submit a bill to medicare, or don’t ask permission to continue to play outside every two years, YOU ARE AUTOMATICALLY BACK IN. i.e. the default, by law, is “participating.
    2. You can order any test or x-ray you want. The patient then can get it at the lab or imaging center of their choice (which imaging center may bill Medicare for the service).
    3. You may be “opted out” AND have a PECOS number.

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