Today, some doctors do not take Medicare payments, and some are even refusing to take private insurance. In recent years, Medicare and Medicaid have both undergone numerous changes. Meanwhile, private insurance plans have been decreasing their reimbursement rates.
It is for these reasons that many health care providers are attempting to make their operations simpler. Unsurprisingly, many doctors have also noted that they have been becoming less satisfied with their work because more of their time is spent dealing with the bureaucratic parts of the healthcare industry that keep growing.
Administrative Hurdles
Over the years, the medical field in the United States has become increasingly regulated. To cover certain treatments and tests doctors now have to spend much of their time filling out form after form to get reimbursement from Medicare and private insurance. This also means that doctors have to hire extra staff to handle additional paperwork, phone calls, form resubmissions, and insurance company negotiations.
Even though additional employees do much of this administrative work, it is still the responsibility of the doctor to make sure that these employees are operating effectively. If not, his practice will not be able to collect on the services they are performing.
By forcing doctors to spend more time doing paperwork and monitoring administrative departments, there are fewer hours in the day to see patients. With less time for patients and increased collection costs, it is no wonder that the cost of healthcare continues to increase.
What makes things even worse is that the process for billing insurance has become so convoluted that insurers can deny coverage for patients that desperately need it.
To get reimbursement from Medicare and Medicaid doctors also face significant risks that keep many of them from accepting new patients covered by the programs today. Under the Centers for Medicare and Medicaid Services, there are strict requirements doctors must follow. If they fail to comply, they could face fines or potential action against their medical license.
According to a recent study in Health Affairs, the seriousness of these penalties has led to the average doctor spending more time checking boxes and reviewing forms than they get with their patients.
Financial Burdens
Today, the financial burdens doctors face making taking Medicare patients a difficult decision. Most people do not know that Medicare only pays doctors 80 percent of what private health insurance pays. The main reason for this is that Medicare funding has failed to keep pace with the cost of care demanded by those enrolled. Ironically, it is the cost of complying with Medicare that only makes the situation worse.
More people should be aware of the true reasons why doctors are doing more business on a cash basis. It is not because they are lazy or do not want to deal with many of the elderly and impoverished people covered by Medicare and Medicaid. They are simply trying to make a living and help as many patients as possible. Unfortunately, the bureaucracy around Medicare in particular makes the future of the program questionable at best. Patients covered by Medicare are the most expensive ones that doctors see and they are the ones that pay the least.
In addition to paying the least, Medicare reimbursement is a great source of uncertainty for physicians and their practices. The soonest that a Medicare claim can be paid is after two weeks but in reality it is often months before healthcare providers are compensated. In addition, the Medicare system is always changing the rates of reimbursement for various visits and procedures.
One of the most recent changes with Medicare is that doctors are only going to be payed a flat rate for office visits. This means that regardless of how complicated the visit is the physician has a price ceiling on what they can bill. Measures like these push doctors away from accepting Medicare patients and with the poor financial condition of the Medicare program things are only going to get worse.
Opting Out of Medicare
Today, the majority of medical providers accept Medicare for insurance and it is a vital part of their practice. Some doctors do opt-in for Medicare and go through the additional process of avoiding the Medicare Physician Fee Schedule. This Schedule is released each year and recommends prices for medical services. Physicians then decide if they want to by a “participating provider” and give up the right to charge more than the recommended fees from the Medicare Schedule. If physicians chose to opt-out of the Medicare Schedule there can charge up to 15 percent more and still be part of the Medicare program.
On the other hand, medical providers are opting out of Medicare than ever before. As of September 2018, more than 22,000 licensed medical providers will not accept Medicare for payment. Instead, they are choosing to serve patients with private insurance or patients that pay for their medical expenses out of pocket.
What Can You Do?
If you rely on Medicare to cover your medical expenses, there are several options. Although it makes more financial sense to find a doctor that accepts Medicare, paying out of pocket for medical expenses and asking for a discount is definitely an option. Many service providers offer reduced rates for cash patients because their practice does not have to incur high administrative costs to process the payment. To find doctors in your area that still accept Medicare all you need to do is perform a search on the Medicare website.
If you have a Medicare Advantage plan, your private insurer will gladly provide you with a directory of physicians in your area that participate with Medicare. It is also important to remember that even if one of these medical providers is listed as a participant in the Medicare program, it does not mean that they are currently looking to take on any new Medicare patients. To see if they are, all you need to do is give the medical provider a call and ask.
Patient assistance programs are another solution. The Allergan patient assistance program covers Botox for example and the Spiriva Handihaler and Respimat medication also has a well established program (Click here for the difference between Spiriva Handihaler and Respimat)
In addition to these solutions,also some have only recently been introduced. One of the newest is the rise of urgent care centers that handle most basic medical issues. Today, there are more than 18,000 of these clinics in the United States. Although many of these clinics are cash only, there are still many that take Medicare patients. For urgent care centers, the American Academy of Urgent Care Medicine has a state-by-state directory of the facilities that accept Medicare patients.
To combat the problems inherent in the Medicare system will be difficult. The greatest source of hope is found in the most innovative parts of the industry. In addition to urgent care centers, there are companies that work with patients to get prescription assistance. By working directly with providers and customers these prescription assistance programs provide a great deal of access and costs savings that were previously unavailable. It is also true that as doctors show more favor towards cash patients, the competition or these cash patients will force doctors to be more competitive with one another and offer greater discounts.
Regardless of your situation, the current wave of innovative medical solutions is the best reason to be optimistic about the mess that is the United States Health Care System.
Sources:
https://www.verywellhealth.com/doctors-accept-medicare-insurance-3976280
https://www.medicare.gov/
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