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Opting Out ofMedicare
AAPSThrive – Not Just Survive XXIV Workshopa!!as"
Te#as$%&'$&'$()
*a+rence ,- .untoon" M--" Ph--Association of A/erican Ph0sicians
and Surgeons
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Reasons for
Opting Out ofMedicare
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Physician Burnout Climbs 10% in 3 Years!its ""%
#Professional burnout among $ physicians hasreached a dangerous
le&el 'ith more than halfof physicians a(ected according to the
results
of a )01* national sur&ey across &ariousmedical
specialties and practice settings+Compared 'ith responses from a
similar sur&eyin )011 burnout and satisfaction 'ith
'or,-lifebalance ha&e 'orsened dramatically e&enthough 'or,
hours ha&e not increased o&erall+.
Physician Burnout Climbs 10% in 3 Years !its ""%
By /iana 'ift
Medscape eurology/ecember 1 )01"
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Physician Burnout#he pre&alence of burnout is higher in
physicians than in other professions and isespecially high in
neurologists+ Physicianburnout encompasses 3 domains2
1(2 emotional ehaustion2 the loss of interest andenthusiasm
for practice4 1'2 depersonali5ation2a poor attitude 'ith
cynicism and treatingpatients as ob6ects4 and 132
careerdissatisfaction2 a diminished sense of personalaccomplishment
and lo' self-&alue+ Burnout
results in reduced 'or, hours relocationdepression and suicide+
4urned&outph0sicians har/ patients 5ecause the0!ack e/path0 and
/ake errors-6
Ph sician Burnout2 7 eurolo ic Crisis
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;!Rs are a Ma6or Contributing
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ncreasing Bureaucracy isa Ma6or Contributor
o
Physician Burnout
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Medicare
Obstructs mpedes andnterferes
'ith
early ;&ery 7spect
Of
he Practice of Medicine
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# 'ould really lo&e to Opt Out ofMedicareD
B$ really canEt do it in my areaD amsurrounded by
competitors all of 'homparticipate in MedicareDand all of
myMedicare patients 'ill lea&e and go tomy competitors if Opt
Out and 'ill beout of business+.
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he Pin,y oe 7pproach to OptingOut
?est the 'ater temperature by dipping yourpin,y toe in the 'ater
before di&ing into thepool@
Conduct a brief 'ritten Surve0 of Medicarepatients as they
come into your oFce+
Surve0 ser&es a dual purpose G helps to
educate your patients about ho' the Medicarebureaucracy
ad&ersely a(ects them andinforms them about the substantial
bene=ts ofbeing treated by an Opted Out /octor+
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he Medicare bureaucracy is increasingly forcing
ourphysicians to spend more and more time onadministrati&e
reHuirements that ha&ing nothing to do'ith pro&iding you
'ith Huality medical care+ pendingmore time on bureaucracy means
spending less time'ith indi&idual patients+ Medicare also
coercesphysicians to ser&e as agents for rationing medical
careso as to sa&e the go&ernment money+ he MedicareProgram
obstructs impedes and interferes 'ith our
ability to pro&ide our patients 'ith good care+
Ourphysicians do not 'ant to ser&e as agents of rationing
forthe Medicare program+ n order to be able to pro&ide you'ith
timely indi&iduali5ed care and the face-to-face time'ith your
physician you deser&e our oFce is
considering re6ecting this go&ernment abuse of ourpatients
and opting out of the Medicare program+ Optingout of Medicare means
that you 'ould pay reasonablefees out of poc,et and not be able to
obtainreimbursement from Medicare for the ser&ices our optedout
physicians pro&ide+ 7ll other labs tests radiologicstudies and
hospital care 'ould be co&ered by the
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Medicare Patient Surve01+ 1+ n &ie' of the fact that
go&ernment
interference in medicine 'ill continue to
restrict our ability to pro&ide you 'ith theHuality care you
deser&e 'ould you be'illing to recei&e higher Huality
carepro&ided by an opted out physicianJ 7ny
CommentsJ)+ n &ie' of the fact that you are already
paying substantial Medicare deductibles andco-pays out-
of-poc,et for go&ernment-
rationed care 'ould you be 'illing to pay alittle more
out-of-poc,et to recei&e bettercareJ ?getting in to see our
physiciansooner and ha&ing more face-to-face time'ith our
physician so that all of your
Huestions and concerns can be appropriately
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pending More ime 'ith Patients as an OptedOut hird-Party-
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Ris,
Of
Prosecution Prison
7nd
Ruinous
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Reco&ery 7udit Contractors ?R7Cs@
?Pri&ate Bounty !unters@
Kone Program ntegrity Contractors?KPCs@ G loo,ing for crimes
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;(ects of ObamaCare
ncreased federal sentencing guidelines by )0-"0% for crimes
o&er 1 million in losses
ncreased license chec,s and site &isits for
physicians deemed to be high ris, for fraud andabuse
CM implemented ad&anced predicti&e
modeling technology to detect fraud
Pro&ided an additional 3"0 million o&er 10years to boost
anti-fraud e(orts
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pending More
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LR
/efeated?7 Cause for CelebrationJ@
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mall practices li,ely to be NlosersE
underM7CR7http2medicaleconomics+modernmedicine+commedical-economicsne'ss
mall-practices-li,ely-be-losers-under-macra
#CM estimates that :% of the nationEs solo practices?nearly
103000 physicians@ 'ill face a penalty in )01
the =rst year of the program to the tune of 300 million+ he
ne's is eHually as pessimistic for practices of t'o tonine
physicians ?an estimated 1)*000 physicians@ 'hocould see penalties
to the tune of ) million.
#here are 'inners and losers Qin M7CR7 and smallerpractices are
more li,ely to be the losers. 9und toldMedical ;conomics+ #t
appears the proposed rule 'ouldcreate a penalty system 'here the
big guys Qlargerpractices 'ill be funded by the little guys+.
mall Practices 9i,ely to be NlosersE under M7CR7 By
Seith 9+ Martin
http://medicaleconomics.modernmedicine.com/medical-economics/news/small-practices-likely-be-losers-under-macrahttp://medicaleconomics.modernmedicine.com/medical-economics/news/small-practices-likely-be-losers-under-macrahttp://medicaleconomics.modernmedicine.com/medical-economics/news/small-practices-likely-be-losers-under-macrahttp://medicaleconomics.modernmedicine.com/medical-economics/news/small-practices-likely-be-losers-under-macra
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ObamaCareM7CR7 7genda
9i,e ObamaCare M7CR7 is designed to
eliminate solo physician and small grouppractices and force
physicians intohospital employment andor large 7COs+
he goal is to eliminate fee-for-ser&icemedicine and
replace it 'ith 7COssub6ect to go&ernment control+
Centrali5ed go&ernment control ofmedicine is the ultimate
ob6ecti&e+
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A) Page Proposed Rule by CM ?
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M7CR7 G 7pril 1A )01"?Medicare 7ccess and C!P Reauthori5ation
7ct of )01"@
10A+ Reducing administrati&e burdenand other
pro&isions
ection 1:0)?b@?3@ of the ocial ecurity 7ct?*) $++C+ 13"a?b@?3@@
is amendedT
?/@ 7pplicable )-year periods for e(ecti&enessof
aFda&its
?1@ nde=nite continuing automaticetension of opt out
election
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Physicians Can o'
Permanently Opt Out ofMedicareUUUr-.untoon8s O9ce
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7lso physicians 'hose aFda&itsare recei&ed after 8une 1A
)01" no
longer ha&e to rene' pri&ateMedicare contracts e&ery
t'oyears+
#ection 10A?a@ of M7CR7 indicates that &alid
opt-outaFda&its signed on or after 8une 1A )01"
automaticallyrene' e&ery t'o years+ herefore physicians
andpractitioners that sign opt-out aFda&its on or after
8une
1A )01" 'ill no longer be reHuire to =le rene'alaFda&its or
ha&e their patients sign 'ai&ers Qpri&atecontracts
e&ery t'o years+.
ami,a 9yons
CM Region OFce
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:actors to ;onsider in Making OptOut ecision
:inancia! ;onsiderations21+ eed to consider the total
re&enue eHuation2
Lross Re&enue G ;penses V et Re&enue
)+ eed to loo, at type of ser&ices you pro&ide
patient
population and ma,e an assessment about ability to
collect
directly from your patients
3+ f you elect to stay in Medicare need to consider thecost of
you and your sta( ,eeping up 'ith e&er-changing Medicare rules
and regulations and thecost of =ling and handling Medicare claims W
appealsrelati&e to re&enue generated
*+ f you decide to Opt Out may be helpful to =nd#niche.
ser&ices if possible and need to thin, aboutho' to de&elop
a mar,eting campaign to inform
patients of the bene=ts of seeing an Opted Out
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M7CR7
Ihat 'ill !appen to PhysiciansIho Remain in MedicareJ
Price Controls G P7B
7lternati&e Payment Models GCapitation on teroids
?ObamaCare 7COs G money paid to
7lternati&e Payment Models ot tondi&idual
Physicians@
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Merit-Based ncenti&e Program
?Iill Replace ;!R Meaningful $se and
Physician Xuality Reporting ystem ?PXR@
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$nder Merit-Based ncenti&eProgram Physicians Iill be7ssigned
a Composite Performancecore ?Minimal Re'ards@
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Non&:inancia! ;onsiderations2
1+ he freedom and pleasure of practicing medicineagain
instead of practicing bureaucracy ?Sic, the #Lorilla.out
of
your ;am Room@ G happiness replaces physician
burnout
)+ Positi&e patient eperience and protecting
patientpri&acy
3+ o fear of ruinous =nes or prison time for
inad&ertentcoding
errors or running afoul of some obtuse Medicare
la'rule
regulation ?Medicare bounty hunters G R7Cs andKPCs no
longer a 'orry@*+ impli=cation G Opt Out physicians need not use
any
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n ma,ing your decision about
opting out of Medicare you shouldchec, all of your contracts
andhospital byla's to insure that there
are no conicts+
f you are unsure as, an attorney
to re&ie' your contracts and anyother legal documents that
may bepertinent+
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Procedure for Opting Out ofMedicare
Non&Participating ph0sicians can opt outof Medicare an0 ti/e
during the 0ear- Acop0 of the opt out a9davit /ust 5eprovided to
the Medicare carrier1s2 no!ater than ($ da0s after the $ da0 grace
period after
+ithdra+ the opt out a9davit- 4e sure tocheck other contracts
and a9!iations ou
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Participating Ph0sicians can only opt
out four times during the year+
he Medicare contractor must receiðe opt out
aFda&it one month beforethe beginning of net calendar
Huarter?8an 1 7pr 1 8ul 1 Oct 1@+
/eadlines for carrier recei&ing opt outaFda&it2
March 1st 8une 1st eptember1st and /ecember 1st+
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Opt Out Ph0sicians ProvidingServices in @rgent or /ergenc0
Situations
An Opt Out ph0sician cannot /ake a ne+contract +ith a Medicare
patient in an
urgent or e/ergenc0 situation-
An Opt Out ph0sician +ho providesservices in an urgent or
e/ergenc0
situation can
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;arly ermination of Opt Out• ot ha&e pre&iously opted
out of Medicare
•
Must notify all Medicare carriers oftermination of opt out no
later than 0 daysafter e(ecti&e date of opt out
• Must refund to each bene=ciary 'ith 'hompractitioner has
pri&ately contracted allamounts collected in ecess of the
Medicarelimiting charge
• Must notify all bene=ciaries 'ith 'homphysician entered into
pri&ate contracts of
termination of opt out and bene=ciariesErights to ha&e
claims =led on their behalf forser&ices pro&ided during opt
out period
Physician is then reinstated to his prior
Medicare status as if there had been no opt out
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7ou can do+n!oad step&50&stepinstructions for
Opting Out" the Opt OutA9davit" Private ;ontracts for @se +ith
Patients" Sa/p!e *etters Infor/ingPatients of 7our ecision to
Opt Out" and
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Ihat 7bout !ospitali5ations 9absRadiology ests upplies and
!ome!ealth CareJ
Physicians 'ho are currently in the Medicaresystem either as a
participating or non-participating physician 'ho opt out ofMedicare
ha&e an P and are in the P;COdatabase
generally should ha&e no troubleha&ing Medicare
pay for hospitali5ations labsradiology ser&ices or home health
care ser&ices
ebsite to +hec to 'ee i ,hysician is in
,+'
http://www.oandp.com/pecos/
http://www.oandp.com/pecos/http://www.oandp.com/pecos/
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Medications and Referrals topecialists are Lenerally ;cludedfrom
the Ordering and ReferringRule
!o'e&er Opted Out PhysiciansIho /o ot !a&e an P
Cannot
Let Part / /rugs Co&ered byMedicare
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Physicians 'ho ha&e ne&er enrolled in Medicaredo not
ha&e to enroll in Medicare in order toOpt Out
7lso for physicians 'ho are not enrolled inMedicare or are Opted
Out and not in theP;CO database there is a special
abbre&iated
enrollment form G CM :""0 G you can use toenroll in Medicare for
the sole purpose ofordering and
referringhttps2'''+cms+go&MedicareCM-
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f an Opt-Out pro&ider elects to order and refer
ser&icesMedicare contractors must de&elop for the
follo'inginformation through an additional information reHuest2
Z 7n P ?if one is not contained on the
aFda&it&oluntarily@4
Z Con=rmation if an OFce of nspector Leneral ?OL@eclusion
eists ?if not contained on the 7Fda&it@4Z /ate of Birth4
and
Z ocial ecurity umber ?if not contained on the7Fda&it@+
f the abo&e information is not obtained the
opt-outpro&ider 'ill not be able to order and refer
ser&ices+ fthe opt-out pro&ider refuses to report the
informationlisted immediately abo&e then the opt-out
pro&idercannot order and refer but the failure to report
this
additional information does not a(ect the pro&iderEs
right
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77P also o(ers hri&e G ot 8$ur&i&e eminars a
couple of times
per year at di(erent locationsthroughout the country ?77P
hadbeen running these 'or,shops for 1*
years@
ee2 77Ponline+org for
Registration and Course /etails7 ta-deductible donationto our
77P ;ducational
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Tips for Opting OutB1+ tart at least A months in ad&ance
of
beginning of Opt Out period+ his pro&ides
time to inform patients of changes and timefor your sta( to
ad6ust+
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f You !a&e peci=c Xuestions
7bout Opting Out of Medicare or ransitioning to a
hird-Party-
