October 25, 2005
Subject: Opting Out of
Effective January 1,
2006, Acute Family Medicine Clinic, Inc. will “Opt Out” of the Medicare
network and no longer be accepting Medicare assignment.
Opting out of Medicare
is not an easy decision. As providers, we are frustrated with keeping
abreast of ever-changing rules and regulations, and tired of being forced to
put Medicare rules above our patients’ needs. As a business, we cannot
continue being paid less than 50 cents on the dollar, months late, after
much effort and expense on the part of our billing staff.
The Centers for Medicare and
Medicaid Services (CMS) has proposed that
physician payment rates will be cut 26% from 2006-2011—including a 4.4%
cut on January 1, 2006. In addition, it is our impression that for 2006
Alaska will lose the special funding that increased Medicare payments
to Alaskan doctors who treat Medicare patients by 50 percent during 2004 and
2005. Meanwhile, our clinic expenses
(supplies, insurance, payroll, utilities, etc.) are increasing at 12-15%
As a result of “Opting
Out,” Acute Family Medicine Clinic, Inc. cannot bill Medicare or receive
payment from Medicare for services on or after January 1, 2006. It also
means that Medicare patients cannot submit claims to Medicare for services
we’ve provided. If you want us to continue providing your medical care, we
will be asking you to sign a private contract with us, as required by law.
The contract includes a “pay as you go” arrangement, in which the patient
would be responsible for paying our fees. Secondary insurance policies
rarely cover fees that Medicare denies, but if you have such coverage,
please check with your agent. The contract cannot be signed earlier than 10
days prior to January 1, 2006.
Needless to say, you
have every right to choose another clinic or provider for your care, and we
understand and respect whatever decision you make. We have a list of
clinics who accept Medicare assignment. Please complete a records release
if you desire us to send your records elsewhere. We value you as
individuals. The fact that we have been forced to make this decision has
left us with a sense of personal sadness and frustration. This was a
difficult decision, but one that is necessary for our viability.
If you have any
questions please do not hesitate to call us.