CMS Might Let Doctors Bill Medicare Patients Directly

The Centers for Medicare & Medicaid Services (CMS) plans to launch a pay model that allows Medicare beneficiaries to contract directly with physicians.

In the current system, physicians are paid under a Medicare fee schedule that limits the amount doctors can bill Medicare beneficiaries per service. The new pay model would allow physicians to opt out of Medicare and contract with their patients. It also would make funds available to beneficiaries upfront, which could be used to pay for services that are not presently covered under Medicare.

In a press announcement of the potential new system, CMS stated that “a direct provider contract model would allow providers to take further accountability for the cost and quality of a designated population in order to drive better beneficiary outcomes.”

The agency added that “such a model would have the potential to enhance the doctor-patient relationship by eliminating administrative burden for clinicians and providing increased flexibility to provide the high-quality care that is most appropriate for their patients, thus improving quality while reducing expenditures.”

Some consumer advocacy groups warn that the new model could result in doctors charging patients inconsistently or selecting patients based on type of illness.

Source: Modern Healthcare, April 23, 2018; CMS press release, April 23, 2018