CMS Seeks to Allow Doctors to Bill Patients Directly
Written by Editor   
Tuesday, April 24, 2018 11:55 AM

The CMS is planning to launch a new pay model that would allow Medicare beneficiaries to contract directly with physicians.

Under current law, physicians are paid under a fee schedule in Medicare that includes limits on the amount they can bill beneficiaries per service unless they choose to opt out of Medicare and privately contract with all of their Medicare patients.  Private contracting would allow physicians to bill seniors for charges that are more than the rates approved by Medicare. These sorts of arrangements are known as balance-billing, a controversial concept that was backed by former HHS Secretary Dr. Tom Price.

Officials for the nation’s largest not-for-profit health system supported private contracting in its comments to the CMS saying this approach would make funds available to beneficiaries upfront and allow them to directly contract for primary care and related services through a subscription payment.  The upfront funding could also be used to pay for services that are not presently covered under Medicare.  “This aspect of such a model would allow both a beneficiary and provider, in partnership to define what has value and create competition for such services.”

In its announcement the CMS said that a direct provider contract model would allow providers to take further accountability for the cost and quality of a designated population to drive better beneficiary outcomes. But consumer advocates slammed the proposal. The AARP said private contracting opens the door for doctors to pick and choose the patients or services for which they will bill Medicare.
"Current rules prevent doctors from choosing patients based on the severity of their illness or other characteristics or charging different patients different amounts," the group said. 
Before the CMS launches the new model, it is seeking additional comments through May 25 on the structure of the program.