Can A Cash-Pay Practice See Medicare Patients?
I treat women. And a lot of women over the age of 65 are still seeking Certified Menopause Specialists for care long after they have gone through menopause. Running a cash-pay practice makes seeing Medicare patients exponentially harder for many reasons. The first is that there is a federal law that states if providers are enrolled in Medicare (which most of us are), we cannot charge a cash-based fee because we have to submit a claim to Medicare showing that services were rendered. Confusing…I know!
Here’s the example I’ll give: I moonlight for an urgent care group that accepts Medicare so I have to be enrolled in the system. This allows me to see patients in that setting and bill them through their insurance. Because of that, I cannot see Medicare patient in my telehealth practice because I would also have to submit claims and deal with denials, refusal of care, etc., instead of just charging my fee and providing the service. This is a safety net to Medicare patients to not get overcharged or exploited, but it is also a great detriment because a lot of women 65 years or older will not be able to see a gynecologist or their primary care provider is not menopause certified.
On the provider end, ignoring this law may make us liable to penalties, audits, and exclusions from the federal government. Eliminating our ability to moonlight in offices that take Medicare but also risking the closing of our cash-pay practices. It becomes a quandry of red tape that is difficult for even the most informed clinicians to navigate. It also means that a lot of Direct Care Practices will not see patients 65 years or older. And it is frustrating, both for the patient and the provider, who would like to establish these relationships! The only safe way to do this is to opt-out of Medicare for 2 whole years, which means that while a business is trying to start, the provider would not have any real options for other sources of income, or it eliminates the option of getting hired should the cash-pay practice close. And most providers are not willing to eliminate all their options and safety nets.
I write all this to say, I love Medicare patients and feel we are doing a great disservice by not allowing them to have free choice in where they are able to go and seek help. As many of us know, there are quite a few gaps in women’s health on a Medicare plan and they frequently deny patients options. I have no good solutions and have consulted with many attorneys who have given the blunt asnwer of, “Don’t do it!”, “No Medicare Patients so your don’t become liable to penalties that will put you out of practice.” I don’t like this one bit. I think we all deserve a choice in how we address our health, but I also want to continue to serve women who are in need of more than the fifteen minute visits and who have been seen by so many specialists and told nothing is wrong. All of this is to say, I’m sorry! I truly want to see you ladies and if or when something changes, will be the first to open up the practice to all ages! In the meantime, I welcome emails with questions and discovery calls to explain this a bit better on a one-on-one basis.
