We have a doc that just opted out of MCR and turned all of his loyal Medicare patients into cash patients...Expecting elderly patients to file their own MCR claims is crazy; even if you fill out the CMS-1500 form for them.
It sounds like your doctor dropped out of Medicare entirely, which CMS refers to as "Private Contract". This isn't the same as "Non-Par". A ?Non-Par? provider bills Medicare directly an amount called the Medicare ?Limiting
Charge?, set at 15% higher than the ?Non-Par Fee?, which itself is 5% less than the ?Par Fee?. Therefore it net gain is about 10% (less the still persistent "sequester").
The problem is that Medicare pays the patient
directly for 80% the ?NonPar Fee?. The patient is then responsible for passing on the Medicare payment to the provider, plus pay for the 20% co-insurance (covered by a secondary policy if the patient purchased such coverage).
Although the patient doesn't have to file the CMS-1500, they have to troubleshoot the opaque CMS EOBs. And of course pay the doctor. But we all do this to collect our Medicare deductible at the start of the year anyway, so you should have some insight on which patients will be collection problems. Our practice has been very strict on terminating Medicare patients who default at 90 days. Usually some family member emerges to straighten things out (not surprising, since there are other financial needs for these patients).
As MACRA turns up the heat, simultaneous with the Baby-Boomer peak, I expect that finding a Medicare-par provider will be challenging, so getting dropped by your doctor for delinquent payment will be risky. I think it's important for patients to realize that when CMS threatens our financial viability, it hurts the customer as well.
