Physicians seek right to balance-bill under Medicare

Payment cuts have reignited doctors' desires to have beneficiaries pay the difference, which is not allowed under current regulations.

By Victoria Stagg Elliott, AMNews staff. Jan. 6, 2003.

New Orleans -- The American Medical Association will advocate that physicians be allowed to bill Medicare recipients the difference between reimbursement rates and the actual cost of services.

The Association's House of Delegates passed the balance-billing resolution during the Interim Meeting here in December 2002.

"It is imperative that we get back to a system where the economic arrangement is between the doctor and the patient," said Bohn Allen, MD, a Texas delegate. "This gives us the ability to not charge those who can't pay and to make the transaction a reasonable business transaction just like every other business person in this world does."

Physicians who take assignment from Medicare are not allowed to balance-bill. Those who do not accept assignment can bill 10% over Medicare rates. The resolution calls for the AMA to lobby in favor of giving both types of physicians the ability to balance-bill and removing the 10% limit.

Doctors testified that such a change is vital to maintaining seniors' ability to access medical care, in light of reductions in Medicare payment rates. The reimbursement cuts are causing an increasing number of physicians to reduce the number of Medicare patients they will treat, if they take them at all.

"I continue to take care of Medicare patients, but it's a struggle," said Melvyn Sterling, MD, a California delegate. "It's a struggle of such magnitude that I've had to tell my office staff to check with me before they accept any new Medicare patients. It's a struggle that spans this entire country and hurts our profession."