General Category > General Questions

TAKING MCR MANAGED CARE FOR EXISTING PATIENTS

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ellie:
We are not contracted with any MCR managed cares. We do however, take MCR traditional card, red/white/blue. The doctor says that if he has an existing patient who has a mcr managed care, he will see them, if a new patient he won't.

I find this alittle troublesome, as a biller.

I don't think he can do this, need your advice.

Thank you

Merry:
But he cannot bill the Advantage Plan, Medicare or the patient. Is he aware of that?

PMRNC:

--- Quote ---We are not contracted with any MCR managed cares. We do however, take MCR traditional card, red/white/blue. The doctor says that if he has an existing patient who has a mcr managed care, he will see them, if a new patient he won't.
--- End quote ---

A physician is INDEED allowed to decide NOT to take on new patients (Medicare or otherwise) This is an alternative many providers went with rather than opting out where they would need to stop seeing their current Medicare patients. The only thing they have to do is keep in consistent, no bending the rules for one over another.

ellie:
I agree, He cannot not bill and/or decide one over the other. He either does or he doesn't, in my case as a biller, I always say no !!!!!!!!!!!

Michele:
He can keep his existing patients but not accept new patients in those plans but the problem is that he may not be in network with the managed care plans so as Merry said he wouldn't be able to bill the patients.  But as long as his policy is "accept existing patients with a change of payer" that is ok.

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