(07-29-2018, 09:46 AM)mikesez Wrote:

(07-29-2018, 09:10 AM)flsprtsgod Wrote: Ah, so you have some limited exposure, that explains your perceptions. It also explains why you think plan participation constitutes a free market. You're still not right but I understand your reasoning.

Would you care to elaborate on this statement from earlier, maybe provide a reference? I'm interested in your explanation.

"Then the government has a rule that says nobody is allowed to pay a lower price than Medicare, except Medicaid."

Some doctors in my wife's field provide free consultations.
Others bill insurance for their consultations.
Her experience is that if you take private insurance, you can bill private insurance for the consultation and also let customers who don't have insurance, be on the "free consultation" or "the cost of the consultation is included in the cost of treatment if you choose to accept the treatment" aka bundled cost program. But it is not that way with Medicare. If Medicare finds out that you're letting some of your clients have a free consultation, they're going to say well gosh I guess the cost for consultation $0, $0 is what you get from us too." And Medicare in general does not do bundled costs.

Interesting, what specialty is your wife practicing? Medicare hasn't paid for consultations since 2010, and United, Blue, Aetna, and Cigna (roughly 85% of the commercial market in NE FLorida) stopped doing so immediately thereafter as well. I'd like to know the reimbursements that you're getting though I'm sure you can't share. And Medicare isn't the only payer who audits based on the fee for service activities of their participating physicians. Blue and United are both interviewing in the NFL region looking for de facto fee schedules; once they find one they start recouping almost immediately. And maybe you aren't up on the current payment model changes, but Medicare is going to be bundling payments almost exclusively in the next 3 years.

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