Summary
Medicare concierge billing involves out-of-pocket fees not covered by Medicare, while providers must adhere to Medicare billing rules. To organize a compliant concierge medical practice, clearly differentiate between services covered by Medicare and those requiring separate fees. Ensure transparency with patients about fees and services, and follow all Medicare billing rules for covered services. Avoid anti-kickback and fee-splitting violations by not accepting payments for referrals and maintaining transparent financial arrangements. When setting up a concierge practice, comply with federal and state billing regulations, separate membership services from those billed to insurance, and maintain transparency with patients and insurers.Full Conversation
what is the best way to organize a concierge medical practice and remain in compliance
When organizing a concierge medical practice, compliance is key. Here's a brief guide:
- Clearly state which services are covered by Medicare and which are not.
- Charge a separate fee for concierge services, not covered by Medicare.
- Maintain transparency with patients about fees and services.
- Ensure all standard Medicare billing rules are followed for covered services.
Do you have any specific questions about setting up your practice?
what services are covered by medicare
Medicare covers a variety of services, including:
- Inpatient hospital care
- Outpatient care
- Doctor visits
- Preventive services (e.g., flu shots)
- Prescription drugs (Part D)
- Durable medical equipment (e.g., wheelchairs)
- Home health care
Is there anything specific you want to know about Medicare services?
how do I ensure I dont violate anti-kick back or fee splitting regulations
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To ensure compliance with anti-kickback and fee-splitting regulations in Medicare:
- Avoid accepting or offering any form of payment for patient referrals.
- Structure financial arrangements transparently and fairly.
- Consult legal experts to review contracts and policies.
- Keep thorough documentation of all financial transactions.
Do you have any specific concerns or scenarios in mind regarding these regulations?
I want to set up a concierge medical practice under Foord Asset Management NV PLLC and file a DBA under Red Rock Concierge Medicine and charge $*/month for being a patient. This would include the exam and wellness coaching. It would not include labs or imaging and I would like to bill their insurance for any procedures that are performed in the office such as I&D, EKG, joint injections.
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When setting up your concierge practice, consider the following:
- Ensure compliance with federal and state regulations regarding billing and insurance.
- Clearly separate services included in the membership from those billed to insurance.
- Maintain transparency with patients about services and fees.
What concerns do you have about the billing process?
I am concerned that insurance companies will kick my billed procedures back if I am operating a concierge practice
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Operating a concierge medical practice while billing insurance can be complex. Here are some points to consider:
- Ensure your billing practices comply with both federal and state regulations.
- Clearly distinguish between services covered by the membership fee and those billed to insurance.
- Maintain transparency in all communication with patients and insurers.
Would you like more detailed information or have specific concerns about the regulations involved?
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