In the past few years, there has been a lot of discussion about physicians limiting how many Medicare patients they will see, or even discontinuing to see Medicare patients completely.

For most doctors offices, the rate at which Medicare pays is not adequate to support the practices running costs.

So the question many Doctors ask is ‘Do I have to participate in (ie. bill payment to) Medicare?

The short is answer is no, you don’t have to. But it is worth considering whether it is a good idea in your area.

Some physicians do not participate in the Medicare program but still see Medicare patients. They do this by charging what is known as a “limiting” charge, which is federally controlled.

Medicaid pays less than Medicare does, and is based on the very low fee schedule. Many ambulatory providers (also known as outpatient care) will not accept Medicaid patients. 

Many Medicaid patients must depend on health departments, hospital clinics, federally-qualified health centers (FQHCs) and rural health clinics (RHCs) for care.

Tricare may be accepted on a case-by-case basis.  A healthcare provider does not need to accept the health insurance for retired military across the board, and may decide individually whether to accept a Tricare patient or not.

If a practice does accept Medicare patients, whether participating or not, there are set amounts to be collected from patients with Medicare. These are in the form of deductibles and co-insurance, as well as services that are never covered by Medicare.

Another area that is confusing to most doctors is what an insurance that is secondary to Medicare will pay.

While some providers do not collect any fees at time of service for Medicare patients with a secondary payer, it can be advisable to at least bill a co-pay amount so that there will not likely be any balance left that is the patient’s responsibility.

The bottom line is that, when running a medical office, there are multiple ways that you can accept payment. Many offices today choose a variety of options based upon their patient demographic and location.