Advanced Primary Care Management- PCP Medicare
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Anonymous
There is a lot you don't understand here. There is no "ethics" problem. And I don't know what you mean by "fronting ... extra costs." Managing patients with chronic conditions comes with a high administrative cost, whether the doctor provided direct care to you in the billed-for-month that you are enraged over or not. Which is why they can still bill for it even if they did not see you. At any rate, they do need your consent to bill for this, so just don't give it if you are going to act this enraged over it. But there is no ethics issue here, just a failure on your part to understand APCMS. And if you are so ready to slam your doctor as having poor ethics, maybe you should find another one? Something tells me they won't mind if you move on. |
Anonymous
It makes plenty of sense, you just don't understand it. |
Anonymous
1. They won't even know. I have seen a doctor or a PA once a year only to authorize yearly bloodwork. Period. I really don't know anyone there. I had to show up 3 years ago after an ER visit for really nothing, and that was my only other visit. That's literally it. I see specialists out of this office that do not communicate with this office. I am dependent on this office for really nothing, 2. Spouse has been seen 2 times this year and met with 2 different PAs. No doctor.t 3. What do you not understand about the fronting of extra costs? This is a PCP practice. They see thousands of patients of all ages. Why is my Medicare being charged monthly for quite a bit of money, outside of the regular insurance cost and any copays, for a separate fee to Medicare, because of the overall patient burden when all these non Medicare patients are not? Is there an assumption that they do not have 2 or more chronic conditions? They pretty much do. The kid next door has asthma and allergies, got Covid 3 times. He's 14. He's in there all the time, while someone like myself is not. I see my own specialists. So why is my Medicare and secondary insurance being charged each month with this surcharge? This is all I am asking. Of course, secondary did not pay it- so now they want the monthly cost from me. I have yet to figure out why. 3. Let me explain how they got my permission. A bunch of forms on a clipboard with this one tucked in at the end the title being " Advanced Primary Care, Medicare." I was new to Medicare and this looked like the form indicating that Medicare is my primary- that is all. It said to the effect that I would be able to get same day appts (never happened to my spouse in these last months) that I could get referrals to their choice of doctors out of the practice for specialty issues( I can make my own, but even so, don't all doctors refer when that is necessary?) 4. Fee? Yeah, the form indicated that my bills are going to Medicare as primary. I think we all understand that if we are on Medicare that is where the bill goes. Any mention that this will be an extra cost? No. Any mention of the cost? No. Yes, it was all pretty vague. And yes, I opted out this month after a bill for $150 appeared in my portal for 3 months, and I checked my EOBs. So yes, it looks like they are using Medicare and Medicare patients to cover the costs for all that are burdening the practice. Medicare is struggling as it is, how is that helping? I am willing to pay more for appts, I actually have 2 insurances (!)I understand this is a problem, in fact I pay for someone else's health insurance currently because of the rising costs- this is someone without a job and cannot afford ACA prices. So, this looks like back door antics to me, sorry. Of course I am leaving the practice. It appears they took on too many patients, perhaps. I would have been easy as I barely go and require nothing really from them. Oh well. I suggest you reconsider this if you are a practitioner, or at least be up front about it. Or= just be concierge as it seems that is the trend. |
Anonymous
I think we all understand it. Sadly. |
Anonymous
Because they are billing the patient. Not just Medicare. |
Anonymous
You just really aren't getting it. At any rate, sounds like you opted out. So stop obsessing over it. And it sounds like this office was up front about it. And you literally signed a consent form. The fact that you didn't read it, and assumed it was something else, is a you problem. |
Anonymous
I'm the one who posted above about ethics and I'm not OP. Just a taxpayer. So there's one other person who thinks it's BS that they can charge without touching her file that month. |
Anonymous
Sigh. Ok. Write to your representatives in Congress if you "think it's BS." |
Anonymous
Good grief, I certainly read it. But, can you read? There was nothing that indicated additional fees at all. Nothing. Just that all my bills would go to Medicare. What's new there, I am not obssesing, I am am answering your comment. My guess is that you are answering with these comments as you are trying to justify what you do. Welp, good luck with that. A lot of people will start catching on and let's see how much more time in your office that takes away from you. |
Anonymous
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APCM is a program designed by and put forth by Medicare to reimburse primary care providers for offering non face to face services to their patients. Medicare says the PCP can bill for these services each month even if in a given month that patient doesn’t use the services.
The doctor is not doing anything sketchy or unethical. These are Medicare’s rules and legitimate billing codes that Medicare created. What is Advanced Primary Care Management (APCM)? Advanced Primary Care Management (APCM) is a patient-centered approach that allows us, as your primary care providers, to receive reimbursement for delivering the coordinated, comprehensive, and personalized care you expect and deserve. Medicare Expanded Covered Services under APCM– Effective January 2025 Medicare will now reimburse your primary care provider for: ● 24/7 on-call access to healthcare providers Prior authorizations for medications Secure online messaging with your provider Comprehensive care management Care coordination between hospitals, specialists, home health, physical and occupational therapy Performance tracking to measure the quality of care provided to Medicare patients Why Are These Changes Happening? ● Before January 1, 2025, Medicare did not provide reimbursement for many of these services. The cost of delivering these services has increased significantly. ○ Adjusted for inflation, Medicare payments to physicians have declined by 33% since 2001. ○ Lower reimbursement rates have caused many physicians to either reduce or discontinue treating Medicare patients. ■ Currently only 1 in 4 Family Medicine specialists and only 1 in 7 Internal Medicine specialists accept Medicare patients. Recognizing the importance of primary care services, The Centers for Medicare & Medicaid Services (CMS) revised Medicare coverage to ensure payment for these essential services with APCM. Frequently Asked Questions Will these changes result in higher costs for me? APCM is designed to reduce overall healthcare expenses. Patients with secondary insurance are expected to have no out-of-pocket expenses. Depending on your insurance, you may have a monthly copay of $3–$10. At the start of the year, the copay may be subject to your deductible and higher initial cost. What if I want to stop these services? You have the right to stop the billing for these services at any time, effective at the end of the calendar month. What if I do not want to sign up for APCM? Right now, APCM participation is not mandatory. However, in the future, it may be required for us to continue to care for medicare patients. Your provider will review the APCM consent form to sign during your visit. |
Anonymous
So, you may want to read my previous comments as it looks like you may have not. Yes, this is sketchy because: 1. There was no review of this paperwork or program. It was a form sandwiched between all the forms on the clipboard. No mention of extra billing or cost. The list of services are the same as any patient, so there is no indication of this being an "excepted" set of services. For those just subscribing to Medicare- it looks like they are confirming that Medicare is primary biller. 2. We do not require month to month, non face to face services. They call in a prescription or confirm a drugstore request 2x a year for spouse. None for me. They do not manage any of our chronic conditions. At all. We do yearly wellness visits only, spouse went in 2 x in Feb, saw 2 different PAs. No doctor. 3. We have **premium** secondary insurance, one of the best in the region and country, for which we pay a lot. They refuse to pay this secondary fee after Medicare. Zilch. Medicare only paid a small fraction of this fee. Now the practice is billing us the remainder. We owe $300 total for Jan,Feb, and March. I see there will be another 100 due for April. So $1200 a year for doctors we do not see, services we do not have. What? We might as well join a concierge practice, for more $$ if we are going to have to do it. I think concierge practices compound the problem, but here we are. How is this not sketchy again? I mean, it's apparently not Medicare fraud, obviously there was a law passed to do it. But, yes, it's unethical and I think fraudulent. I am being billed for services I do not receive. |
Anonymous
Oh my goodness. You are just being obtuse in response to multiple posters who have gone out of their way to explain something that isn't even that complicated. |
Anonymous
You are the same poster saying the same thing, with zero comprehension. Just cannot read, apparently. |
Anonymous
| Sounds like these practices are betting on some idea that over 65s are doddering old fools and wouldn't figure this out. This makes me want to forgo taking Medicare later and just stay with my insurance. Better for everyone involved. |
Anonymous
not the same poster. You are the one not comprehending the concept.
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