Reply to Advanced Primary Care Management- PCP Medicare

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[quote=Anonymous][quote=Anonymous]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.
[/quote]

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.

[/quote]

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