Contracting
Ask the Expert: When Physicians Terminate Medicare Part B Contracts
October 25, 2012
11:33 am
Q: If physicians decide to terminate their Medicare Part B contracts, and those physicians provide services for patients in the hospital, will the hospital still be paid under Part A for the services delivered? In addition, can the physician make arrangements to provide the services to the Medicare beneficiary on a self-pay basis? If they can bill the patient as self-pay, would the hospital be paid for the Part A services?
A: According to WPS Medicare Customer Service, there would be no impact to the hospital reimbursement. If the hospital is participating, they are paid at a case rate for an inpatient stay. Medicare does not pay for physician services under Part A; so the physician’s status does not matter.
The physician will be impacted when they bill for Part B services. All physicians must submit claims to Medicare whether they participate or not, according to a CMS fact sheet, The Basics of Medicare Enrollment for Physicians and Other Part B Suppliers.
They are paid at a lower rate by Medicare, and I believe have the option to balance bill the patient for the difference. I do not know this for a fact but believe it to be true since coverage for these additional charges is an option in Medicare Supplement Insurance Plans.
Paula R. Dillon, director of managed care, Rockford Health System, Rockford, Ill. answered this question.
