Provider Status and Volunteer Teaching at UCSF
As of October 2015, Dr. Forster is no longer “opted out” from Medicare. This change was necessary for him to continue to serve as a volunteer clinical faculty member supervising residents in the Bipolar Clinic at UCSF. He has a long standing commitment to teach young psychiatrists and has volunteered thousands of hours doing so.
UCSF (as well as every other psychiatry training program) relies on special funds from Medicare that support residency training programs. These funds are linked to billed sessions for Medicare patients seen at UCSF. Medicare doesn’t allow a provider to be “in network” in one location (UCSF) and out of network at another location (Gateway Psychiatric Service).
As an in network Medicare provider, Dr. Forster has to process all claims for Medicare patients at Gateway according to the special Medicare rules. And, unlike the situation with other insurance programs, violations of Medicare rules potentially lead to criminal charges. Unfortunately, Medicare billing rules are much more complicated than the rules governing other insurance programs.
With the small number of Medicare patients at Gateway, the extra work involved in billing for Medicare patients is not handled efficiently. To give you and idea of what is involved, we have had to set up a separate banking account for Medicare reimbursements, submit and resubmit Medicare claims (there are frequent disallowances), and place frequent calls to Medicare to resolve disallowances,
Finally, Medicare reimburses psychiatrists much less than it reimburses other doctors (Medicare is excluded from mental health parity laws).
The result of all this is that Gateway Psychiatric was earning 15-20$ an hour for Medicare patient visits to Dr. Forster, after subtracting overhead and billing staff time.
Current Status of Medicare at Gateway
Since the low reimbursement also was tied to a risk, however small, of criminal charges for billing incorrectly, we have decided that we are no longer going to bill for Medicare patient visits to Dr. Forster.
We will provide the community standard 25 minute medication appointments to Medicare patients without any charge.
We will no longer be able to routinely offer longer visits and initially, all of these appointments will be scheduled on Thursday mornings.
Medicare Noncoverage of Services
We will continue to offer to his Medicare patients services that are not covered by Medicare. These services are described in the Advanced Beneficiary Notification form that all Medicare patients at Gateway Psychiatric sign. They include: administrative staff time resolving prescription issues for patients, advocating for coverage of medications or treatments that are not usually covered by Medicare, etcetera. We will do our best to remind you when we offer to provide you a service that is not covered, but you should know that, in general, the services covered by Medicare are limited to in person visits with the psychiatrist.
As in the past, Dr. Forster is the only clinician at Gateway Psychiatric who is “opted in” for Medicare. Visits with the other therapists are handled as in the past. Medicare patients must sign a form indicating that they understand they are responsible for payments for therapist services and may not submit statements for those services to Medicare.
Because providing free care is not something that we can offer to new patients, Gateway Psychiatric is not accepting new Medicare patients for psychiatric (medication monitoring) services. There is no exception to this policy.
It does not matter if a new patient wants to pay out of pocket. They may not do so by law. The Social Security Act (Section 1848(g)(4)) requires that claims be submitted for all Medicare patients for services rendered on or after September 1, 1990.