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concierge medicine
Agreement between a patient & physician for which the patient pays an annual fee for increased access to that physician.
Notes:
- physicians choosing concierge medicine have elected to opt-out of Medicare
- this opt-out decision applies to all patients in the physician practice, he/she may not choose Medicare for some, concierge for others
- the physician must sign an affidavit agreeing to forego any payment from Medicare for a 2 year period
- physician must file an affidavit 30 days prior to the 1st day of the next calendar quarter
- for 90 days after the effective date of the 1st opt-out affadavit, a physician may change their mind & return to providing Medicare coverage
- contract between physician & patient must be in writing & signed prior to providing any services
- patient must give up Medicare payment for concierge medicine services
- patient must agree not to bill Medicare or ask physican to bill Medicare for concierge medicine services
- patient is liable for all physician's charges without any Medicare billing limits
- patient must acknowledge that Medigap or other supplemental insurances will not pay for concierge medicine services
- contract cannot be signed when a patient is facing an emergency or urgent health issue
- patient has right to recieve services from physcian(s) participating in Medicare [3]
- Medicare part D coverage may provided for pharmaceuticals precribed by concierge physicians [3]
References
- Medical Knowledge Self Assessment Program (MKSAP) 16
American College of Physicians, Philadelphia 2012
- Doherty R
Assessing the Patient Care Implications of "Concierge" and
Other Direct Patient Contracting Practices: A Policy Position
Paper From the American College of Physicians.
Ann Intern Med. Published online 10 November 2015
PMID: 26551655
http://annals.org/article.aspx?articleid=2468810
- Geriatric Review Syllabus, 9th edition (GRS9)
Medinal-Walpole A, Pacala JT, Porter JF (eds)
American Geriatrics Society, 2016