Re: Tricare --> was RE: Opting out of Medicare

[Guest guest]

I've been confused by Tricare, too, and haven't had the time to figure

it out in detail. What I've found:

I couldn't even start signing up to be a Tricare network provider

until I had my Medicare number. So, for that, you have to take Medicare.

One Tricare rep told me that a patient could not be reimbursed for my

services until my Tricare credentialing is done.

Another Tricare rep told me that I will get paid MORE, without

difficulty, if I am NOT a network provider.

(All of which is entirely separate from Tricare for Life/WPS...)

Haresch

>

> More info...

>

>

> http://www.tricare.mil/Factsheets/viewfactsheet.cfm?id=294

>

> How TFL Works with Providers who Opt-Out of Medicare

>

> W hen you see a provider who doesn't take Medicare and requires you

to sign

> a private contract, you give up Medicare payment for services that

otherwise

> would be covered by Medicare. TRICARE processes the claim as a

second payer

> as long as the service is a benefit under TRICARE, and the provider is

> TRICARE-authorized. TRICARE pays what it would normally pay if Medicare

> processed the claim (20 percent of the TRICARE allowable charge).

You are

> responsible for the remainder of the bill.

>

> If you have no choice for reasonable access to medical care but to

use an

> opt-out provider, TRICARE may recognize the hardship situation and

grant a

> waiver to allow TRICARE to be primary payer on an individual case

basis. To

> get a waiver, provide an explanation as to why care was not otherwise

> available from a Medicare participating provider. Please contact the TFL

> contractor for detailed information about the opt-out waiver process.

>

> Locke, MD

>

>

> _____

>

> From:

> [mailto: ] On Behalf Of Locke's in

> Colorado

> Sent: Friday, January 11, 2008 6:13 PM

> To:

> Subject: RE: Opting out of Medicare

>

>

>

> Not sure how accurate...

>

>

http://www.tricare.mil/mybenefit/ProfileFilter.do;jsessionid=HLTVFG6GKwF3bQ6

>

rn9n1v0yFStpVcNP4sC40cJdpGsTk5gJLTh6n!-1126241923?puri=%2Fhome%2Foverview%2F

> Plans%2FForLife%2FProvidersWhoOptOutMedicare

>

>

>

> TFL and Providers Who Opt Out of Medicare

>

>

> When you see a provider who doesn't take Medicare and requires you

to sign a

> private contract, you give up Medicare payment for services that

otherwise

> would be covered by Medicare. TRICARE processes the claim as a

second payer

> as long as the service is a benefit under TRICARE, and the provider is

> TRICARE-authorized. TRICARE pays what it would normally pay if Medicare

> processed the claim (20 percent of the TRICARE allowable charge).

You are

> responsible for the remainder of the bill.

>

> If you have no choice for reasonable access to medical care but to

use an

> opt-out provider, TRICARE may recognize the hardship situation and

grant a

> waiver to allow TRICARE to be primary payer on an individual case

basis. To

> get a waiver, provide an explanation as to why care was not otherwise

> available from a Medicare participating provider.

>

> Please contact the TFL contractor for detailed information about the

opt-out

> waiver process.

>

>

>

>

>

>

>

> Last Modified: September 18, 2007

>

> This is from 2005, but...

>

> http://www.aapsonline.org/medicare/tricare.htm

>

> snip-snip

>

> In general, here's how we were told things to work:

>

> * For the most part, TRICARE reimbursement rates, known as CHAMPUS

> Maximum Allowable Charge (CMAC), are the same as Medicare. The most

noted

> exceptions of OB/GYN and pediatrics, which don't generally lend

themselves

> to the over-65 Medicare population. So financially, accepting

TRICARE is the

> same as accepting Medicare. Although legally TRICARE and Medicare

may affect

> a physician's practice differently.

>

> * A physician is allowed to accept TRICARE, but opt-out of Medicare.

> The reverse, however, is not the case; if a physician accepts

Medicare, he

> must accept TRICARE. Institutions (hospitals) do not have this

option. They

> must accept or reject both. See

http://www.tricare.osd.mil/CFR/C6.PDF for

> balance billing regulations of Non-Participating (but Authorized)

Providers.

>

>

> * Somewhere TRICARE policy specifies that a physician accepting

> Medicare, must also accept TRICARE. But, because TRICARE policy does not

> address the case of accepting TRICARE but opting-out of Medicare,

this is

> allowed-as far as we can tell. We cannot offer definitive legal

advice on

> this point.

>

> * A reasonable guess might be that Participating and Network Providers

> must accept Medicare, but an Authorized (only) Provider may opt-out of

> Medicare. That is to say, becoming a TRICARE Participating or Network

> Provider probably entails accepting Medicare.

>

>

> Locke, MD

>

>

>

>

>

>

>

>

>

> Opting out of Medicare

>

> Does anyone know if opting out of Medicare also means that you

cannot see

> Tricare Standard patients as well? There was brief mention of this

in the

> Jan 08 FP Management article titled " Does Primary care Need Medicare? "

>

>

>

>

>

>