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FAQs
Medicare Opt-Out NewsWe have performed an extensive review of our practice and concluded that some of our physicians will be opting out of Medicare. Our analysis clearly demonstrated that the unsustainable situation created by the Centers Medicare and Medicare Services (CMS) administrative requirements, rules, regulations and declining reimbursement created the need for us to move in this direction. We want to reassure you that only 6 of our physicians have chosen to opt-out at this time. These physicians have a very low percentage of Medicare patients. The POC physicians that have chosen to opt-out have established a reasonable discounted fee for service schedule to treat those that still want to see them. It is our understanding that all other Medicare reimbursement associated with the opted-out doctor’s care will be covered including hospital and ambulatory surgery center fees, physical therapy, drugs, and imaging studies performed outside the doctor’s office such as MRI, CT scans. We would like to try to answer as many of your questions as possible. Please view the link below for further information. We know that many of you will have questions about the decision of a few of our physicians to opt out. Please refer to the list of questions below that hopefully, will provide an answer for you.
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Which physicians are opting out?At this time, a small portion of our physicians have opted out. While we await the outcomes of additional changes in Medicare, we wanted to minimize overall disruption to POC patients The physicians that are opting out have a very small percentage of Medicare patients. Physicians at POC that have chosen to opt-out: James Beskin, Xavier Duralde, Lee Kelley, Donald Langenbeck, Stephen McCollam, and Hal Silcox. [ Back to Top ] |
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What about all other Medicare expenses associated with my care?It is our understanding that all other Medicare reimbursement associated with the opted out doctor’s care will be covered including hospital and ambulatory surgery center fees, physical therapy, drugs, and imaging studies performed outside the doctor’s office such as MRI, CT scans. [ Back to Top ] |
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Is there any way I can still see my current doctor?What will it cost me? Yes – you can enter into a private contract with your physician and have access to a discounted fee schedule. We have a sample fee schedule that we can provide you to assist you in making this decision. [ Back to Top ] |
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What happens if I see my doctor before July 1st?We will file the claim to Medicare on your behalf for visits up to June 30, 2010. [ Back to Top ] |
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How long will this last?A minimum of two years – we will reevaluate at that time. [ Back to Top ] |
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Can you recommend another doctor?Absolutely – your physician can suggest another POC physician or a community physician as appropriate. [ Back to Top ] |
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What about prescriptions, what if I need a refill?Your physician can handle any refill during your transition period or long term if you enter into a private contract. [ Back to Top ] |
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What if I just had surgery?Your physician will provide the appropriate follow up to your surgery for a ninety day period. After that period, you can enter into a private contract or we can suggest another physician. [ Back to Top ] |
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What if Iʼm still doing my rehab?Your rehab will not be affected. [ Back to Top ] |
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What if I have a complication from surgery?Or an issue with an implant? Your physician will provide the appropriate follow up to your surgery for a ninety day period. After that period, you can enter into a private contract or we can suggest another physician. [ Back to Top ] |
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What if I need a second surgery (meaning second foot, knee, etc or revision)?You may enter into a private contract with your current physician or we can suggest an alternative physician. [ Back to Top ] |
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What if I have an upcoming surgery?If the surgery occurs before July 1st, it can continue as scheduled. If the surgery was scheduled after July 1st, you can enter into a private contract or we will need to suggest another participating physician. [ Back to Top ] |
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Is this just about money?CMSʼ administrative requirements, rules, regulations as well as declining reimbursement contributed to this decision. These requirements take precious time away from the physicians that could be spent with patients. [ Back to Top ] |
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Did the recent federal healthcare bill cause you to opt out of Medicare?The federal healthcare package just passed added additional regulatory burdens, liabilities, and uncertainties that did contribute to the doctor’s decision to opt out of Medicare. [ Back to Top ] |
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Is this just traditional Medicare – what plans are affected?Any government related plans are affected – Traditional Medicare,Manage Medicare, Medicare Advantage and Tricare are all included. [ Back to Top ] |
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Does this only apply to new patients or current patients as well?This will apply to all patients currently seeing physicians who have opted out. [ Back to Top ] |
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What will happen to my patient file/medical record?We are required to maintain records for all patients for at least 7 years. We will be happy to provide a copy of your record to another physician if necessary. [ Back to Top ] |
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Will you offer payment terms?Yes, payment options are available. [ Back to Top ] |
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