User-agent: * Allow: / # Optimization for Google Ads Bot User-Agent: AdsBot-Google-Mobile User-Agent: AdsBot-Google Disallow: /_api/* Disallow: /_partials* Disallow: /pro-gallery-webapp/v1/galleries/* Sitemap:
top of page

Medicare vs. The Mafia

In my consulting experience, the question about taking Medicare in private practice comes up frequently. Providers assume that once they start seeing and billing for Medicare patients it is kind of like being in the Mafia "once you are are in for life." This simply is NOT true. I spoke directly to a lady named Jasmine at CMS and got the answers, without having to dig through all the government mumbo-jumbo on the CMS website.

When you are opening your private practice it is like "starting over." You get to choose whether to not you will want to take Medicare or not. However, if you have been billing in a group setting there are a few things you need to do.

Get the group you are leaving to submit a CMS Form 855 to Medicare to disenroll you from the group/facility that is currently billing on your behalf. This tells Medicare that the group or facility practice will no longer be billing for you.


Make a decision as to whether or not you want to continue to see Medicare patients in your new private practice. You have three options.

  1. Opt-in with Medicare and get credentialed at your new practice and start seeing and billing Medicare patients.

  2. Opt-out with Medicare and make your patients sign an Opt-Out Affidavit, and have each beneficiary sign a Private Contract. This basically says that the patient, any of their beneficiaries, nor you will ever bill Medicare for the services you are providing - now or anytime in the future.

  3. Choose not to re-enroll in the Medicare Program, advise all Medicare patients that you do not take Medicare, but let them know they can submit their claim to Medicare themselves to attempt to get re-imbursement. The patient would pay out of pocket to you first and submit the claim to Medicare themselves.

I hope this clears up some misconceptions out there that are floating around. If you have any further questions or need assistance in setting up your private practice, please contact Silver Leaf Practice Management Solutions, LLC and we will be glad to help you.

Please keep in mind that CMS rules change, and if you are reading this blog a year out from its original post, you may want to contact CMS directly at to insure that the rules have not changed.

34 views0 comments


bottom of page