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Can You Bill Medicare if You Run a Cash Based Practice?

Daniel Paull MD explains how you can bill Medicare if you run a private practice.

January 8, 2024

So if you run a cash based medical practice, and you have a Medicare patient that wants to see you, what do you do?

If you do it wrong, it will be illegal and could cause you some trouble.

For Medicare patients, you can only charge them cash for covered services (something Medicare would pay for), if you have opted out of Medicare and have them sign a document stating that you have opted out of Medicare.

That is legal.

 

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What you can’t do is be in network with Medicare, and then decide that you are going to just charge them cash, even if you both agree on it.

If you opt out of Medicare, you can opt out with prescriber privileges, meaning that Medicare will still cover the things you order, even though they won’t cover your services. This is what I do.

The opt out period is two years, which automatically renews, so once you opt out, you have two years before you can opt back in.

 

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If you aren’t sure whether you want to opt out of Medicare yet, then just don’t see Medicare patients and charge them cash. You can always figure that out later.

On a side note, Physicians are able to opt out of Medicare, but most chiros and physical therapists can’t.

All this and more covered in the CME course that I created: Insurance Free Medical Practice Creation

All opinions published on SomeDocs-Mag are the author’s and do not reflect the official position of SoMeDocs, its staff, editors. SoMeDocs is a magazine built with the safety of free expression and diverse perspectives in mind. For more information, or to submit your own opinion, please see our submission guidelines or email opmed@doximity.com. Do you have a compelling personal story you’d like to see published on SoMeDocs? Find out what we’re looking for here and submit your writing, or send us a pitch.

All opinions published on SomeDocs-Mag are the author’s and do not reflect the official position of SoMeDocs, its staff, editors. SoMeDocs is a magazine built with the safety of free expression and diverse perspectives in mind. Do you have a compelling personal story you’d like to see published on SoMeDocs? Submit your own article now here.

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