We want to put our focus on our patients, not their paperwork. Read more about why we have opted out of Medicare and what that means for you.
- Open Letter to Medicare Patients
- Open Letter to Physicians
- Physician status options regarding Medicare
- Medicare Private Contract
Open Letter to Medicare Patients
To our Present and Potential Patients:
First and foremost, both Drs. Harris and Broome see and care for patients whose insurance is Medicare every day. They are every bit as much a part of our family as every other patient. Yet there is some information we would like to share with you about why we do not file to Medicare.
The law that brought Medicare into existence in 1965 specifically prohibits the government from engaging in the practice of medicine. Unfortunately, each year, the government becomes more involved in the day to day care of individual patients. Guidelines and reporting requirements increase; often to the detriment of the patient. The individual patient becomes lost in the amount of paperwork that must be filed. In order to continue to provide each patient with state of the art, personalized care, Drs. Harris and Broome have both opted out of the Medicare program. Participation in Medicare is voluntary; both of us have opted to focus on the patient, not the paperwork.
What does this mean for you as a patient?
An opted out physician does not accept Medicare as insurance. Meaning, we will see Medicare patients, we will just not file to the insurance company for reimbursement. You get many benefits when your care is provided by an opted out physician.
- Your treatment is customized to fit you, and not a government defined population. Physicians who accept Medicare as insurance need to spend time collecting information that has no relevance to your orthopedic issues. Then, they must spend additional time completing forms and sending this information to the government. The opted out physician can instead spend this time with you, the patient.
- We also respect your privacy. You can always see your own medical records, but nobody outside of this office will see your records without a subpoena. The Medicare provider must transmit your personal information to the government.
Next, care directed by an opted out physician to a Medicare provider is covered by Medicare. So, for those who require special tests, or who have opted for surgery, the imaging centers, hospitals, physical therapists, anesthesiologists etc. are all covered by Medicare in the usual fashion. Only the opted out physician is not covered. Our services are provided on a fee for service basis under a Medicare Private Contract. If you’ve not already signed one, please do so now.
In closing, we promise to do everything in our power to provide personalized, excellent service at an affordable price. We believe that there is value in that. We hope that you agree.
Thank you for your time and attention.
Adam I. Harris, M.D. and C. Brandon Broome, M.D.
Open Letter to Physicians
Most of you know by this time, that I’ve opted out of Medicare effective July 1, 2008. I have found that there still seems to be confusion concerning what it means to be an “opted out” physician and how that affects the care of your patients. I want to, by means of this letter, explain this status clearly, as this status allows me the opportunity to improve the care provided to Medicare patients.
First and foremost, I am happy to see Medicare patients. Currently, Medicare patients compromise about a third of my practice. No matter what you might hear to the contrary, Medicare patients are welcome in this office. I do not have any need nor any desire to limit the number of Medicare patients in the practice for any reason.
Opting out of Medicare concerns only me and my fees. Medicare will cover the hospitalization costs and will cover all the ancillary issues such as physical therapy or medications in their usual manner. My bill constitutes only about 5% of the total bill for a surgery. Further, in true cases of need, I am now allowed to provide discounted services without having to pass the same discount along to all patients in the practice.
Many secondary insurance plans will cover some of the expenses that arise out of this office. It is interesting to note, Tricare will kick in their usual percentage of Medicare Allowable fees when their insured see opted out physicians. My office will cover the billing of secondary insurances.
At the same time, there are some opportunities for real savings. For example, I have set my fees for total joint replacement, with the most modern techniques, at about that which I charged for the traditional techniques in 1990, when I first charged and collected for my own services. (Not adjusted for inflation.) An informal survey of my patients showed that most people expect fees far in excess of the real number. Patient’s guesses ranged from three to nearly twenty times the real fee.
The bottom line here is that it is my pleasure a to see Medicare patients. I want to “make it work” for as many of your Medicare patients as possible, and, as always, it is a pleasure assisting in the care of your patients.
Adam I. Harris, M.D
Physician Status Options Regarding Medicare
The Participating or PAR physician is, today, the most common, but also the fastest shrinking group. PAR physicians bill and collect directly from Medicare. PAR physicians are subject to all the compliance rules, regulations, as well as reporting requirements established by the government. There were, before ObamaCare, more than 130,000 pages of regulations concerning how a physician should run their office. Violation of any of these regulations can result in fines of more than $10,000 for each occurrence. Most PAR physicians have had to hire additional personnel or outside services to document compliance, avoid fines, and potentially gain some small incentives from the government.
These doctors are allowed to charge a small amount more than the Medicare allowable. However, they collect from the patient, and the patient collects from Medicare. NON-PAR physicians are also limited in their fees. NON-PAR physicians are subject to all of the same rules and regulations as PAR physicians.
Opted out physicians are freed from almost all Medicare requirements. Neither the physician nor the patient can bill Medicare. The financial relationship remains between the patient and the physician and is a fee for service basis. The fee is set between the two and is not regulated by the government. While the PAR and NON-PAR physician must have documentation that they made every effort to collect all co-pay amounts, the Opted Out physician may, at his or her own discretion, provide discounts or free service to their patients.
All ancillary services ordered by the opted out physician at facilities that accept Medicare are paid in their normal manner by Medicare.
The only rules and regulations to which an Opted Out physician is subject are those required to protect the ancillary services required by patients. Two quick examples, one is reasonable, the other not so. For the hospital to be paid by Medicare, the hospital must document and report compliance with many rules relative to the hospital stay. Perioperative antibiotics (antibiotics given during the course of the operation) is one such reasonable regulation. On the other hand, there are requirements for the documentation of failure of non-operative treatment prior to elective surgery that increase the overall cost of treatment and potentially limit outcomes. Many of these requirements also apply to all patients of Medicare age whether Medicare is their primary insurance or it is not.
Dis-Enrolled physicians have no relationship with Medicare. The patient of the Dis-Enrolled physician pays fee for service not only for the care by the physician, but also for any and all ancillary services ordered by the Dis-Enrolled physician.
Medicare Private Contract
First and foremost, all Medicare patients, and Medicare age patients are welcome in this office. All doctors hold to our mission statement:
“The physicians and staff of San Antonio Orthopaedic Specialists are dedicated to providing excellence in subspecialty orthopaedic care and to treating each patient as if they were family. We are committed to meeting the requirements of all applicable laws and regulations and will not tolerate unlawful or unethical practices.”
The government’s priorities though are a bit different. The intense regulatory environment is not always aligned with good patient care. In short, “good medicine” and “Government medicine” are not exactly the same.
All of our doctors see patients with Medicare as insurance and with Medicare replacement insurance. Dr. Garcia will bill to Medicare, and Drs. Harris and Broome will see Medicare patients on a fee for service basis. The fees are set so that those interested in either Dr. Harris’ or Dr. Broome’s care can afford to do so. Our goal is to provide quality care to all patients.
The government requires that patients sign a private contract to receive care from an opted out physician. This contains specific government required language. Please be sure that you receive one. Please ask any questions that you have about the document before signing.
If you are a new patient, or a returning patient who hasn’t visited us in three years or more, visit our patient information page to fill out new patient forms. For patients on Medicare, visit our patient information page to learn more about setting up a treatment plan that is right for you.
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