Many pts have stated that they can only find a physician that will provide services on a CASH BASIS. For a physician to accept assignment or is a Medicare participating provider means that the physician will bill Medicare and Medicare will pay the physician directly and if the pt has a supplemental insurance … they will pay the physician directly as well.
For a physician to be a CASH ONLY basis is considered a non-participating provider. However, there are certain rules for non-participating providers that they may not be aware of and may be violating.
https://www.medicare.gov/your-medicare-costs/part-a-costs/assignment/costs-and-assignment.html
It is a pretty slippery slope for non-participating physician… they may be required to submit a bill to Medicare on behalf of the pt and they may be limited to charging the pt no more than 15% of what is allowed by Medicare for a participating physician.
Now I know that many pts will say that they don’t piss the physician off for bringing this up while currently being a pt. That does not mean that the pt should not document… document… document.. the charges you have been charged… I hear nearly every day from pts that are being toss from a physician’s practice for little/no reason… and/or their opiate doses are being lowers along with their quality of life.
Once a pt has been “kicked to the curb” is the time to bring out all of their documentation and file complaints with CMS (Center for Medicare/Medicaid Service ) www.cms.gov ( 800 MEDICARE) for the physician failing to follow the Federal law and overcharging the pt and failure to file claims on the pt’s behalf.
Filed under: General Problems
Does this apply if you do not have Medicare and you selected a Medicare Advantage Plan instead (Human Choice PPO)?
MA plans are regulated by CMS and must provide the same benefits as Medicare at least that said however I am unsure if that also applies to out of network doctors since many docs accept Medicare but do not accept all MA plans ! Hope that helps