Medicare Resources

Medicare was created in 1965 as part of the Social Security Act. The program was divided into two parts. Part A is hospital insurance and helps to pay for care provided in a hospital, skilled nursing facility, nursing home, or hospice. It covers the room, board, and ancillary charges billed directly by the facility. The covered portion of expenses is based on the number of days the patient has received care. Part B covers the professional services of physicians and nonphysician healthcare providers and a variety of outpatient services including x-rays, laboratory work, and durable medical equipment. As a psychiatrist, you will almost always be working with Part B.

Medicare currently pays 80 percent of the allowed fee (with the patient being responsible for the rest). If a patient has a Medigap policy (supplemental insurance), that insurance may pick up the patient's entire copay or some of it. 

Physicians may choose to be either participating or nonparticipating Medicare providers. Participating providers must "accept assignment," which means they are responsible for filing the claims for treatment to Medicare patients and are paid the Medicare-allowed fee. Nonparticipating providers may charge slightly more than participating providers, up to a limiting charge that is about 9% higher than the participating provider fee. Nonparticipating providers must file claims with Medicare, but the patient pays the entire fee up front, and is then reimbursed by Medicare. 

You can "opt out" of Medicare by filing an affidavit with your Medicare Carrier (Palmetto GBA in North Carolina) that states you will not see any patients under Medicare for a period of at least two years. Once you have opted out, Medicare allows for private contracting between a physician and a Medicare beneficiary. 

Opting Out of Medicare

As of June 16, 2015, when you opt out, that status will automatically renew every two years unless you inform the Medicare Administrative Contractor for your geographical area within 30 days before the next two-year period begins that you wish to change your status.

• NCPA News Article about Opting Out
• Palmetto GBA's Affidavit template (complete and print; return using the address on the bottom of the form)
• APA's Opting Out Resource page 
• Sample Private Contracting template

Contacting Palmetto GBA:

• Provider Contact Center: 855-696-0705 (TDD: 866-830-3188)