Fam Pract Manag. 2005 Jul-Aug;12(7):65.

Opting out of Medicare


I have contracts with four insurance plans, including Medicare. Can I stop accepting new Medicare patients while continuing to accept new patients on the other plans? If so, can I still see new Medicare patients who want to pay out of pocket? Can they then submit for reimbursement?


Yes, you can stop accepting new Medicare patients while continuing to accept new patients on other health plans.

However, you cannot see either new or established Medicare patients who want to pay you out of pocket unless you opt out of Medicare. When you “opt out,” you privately contract with your Medicare patients for your services. The patient agrees to pay your charges, and both sides agree not to submit any claims or receive any payment from Medicare for your services.

Unless you opt out, you are expected to file claims on behalf of your Medicare patients and abide by the applicable Medicare payment limitations. This is true whether you are a “participating” or “nonparticipating” Medicare physician.

For more information, see “Medicare Participation” in “Ask FPM,” September 2003, and “How to Opt Out of Medicare,” November/December 2003.

Negotiating salary as a percentage of collections


I want to renegotiate my salary and would appreciate answers to the following questions: What is the typical overhead percentage for a family medicine office? Is malpractice insurance usually included? And what is the typical compensation as a percentage of collections?


Average overhead for a family medicine practice with or without obstetrics is approximately 64 percent of collections, according to the Joint Statistics Report of the National Association of Healthcare Consultants. The cost of malpractice insurance is reflected in this figure. If malpractice rates are especially high in your area, this average might not reflect your situation very accurately. Unfortunately, data on overhead expenses in different regions of the country is hard to come by.

Given that 64 percent of collections goes to overhead, you should expect to receive less than 36 percent of collections. Remember, from that 36 percent the employer must pay state-mandated contributions such as disability and worker's compensation insurance, which comprise about 11 percent of compensation or 4 percent of collections. Any other benefits you receive, such as health insurance or continuing education reimbursement, must come out of the remaining 32 percent. The numbers can vary if collections and overhead are above or below the median in your region.

Converting to numerical filing


I would like to convert from an alphabetical to a numerical system for filing patient charts to make it easier for our growing practice to add new charts. I am tired of having to periodically reorganize our chart room and double-check that I don't have two patients by the same name. Do you know of an easy way to do this?


The drawback to a numerical filing system is that a patient's number must always be looked up before the chart is pulled. If you don't mind having to do that, it should work well for you. It is relatively easy to generate unique random numbers using Microsoft Excel's “Random” and “Advanced filtering” functions. To generate record numbers up to seven digits enter “=RAND()*1000000” into a cell. This will generate a random number from zero to 1 million. Next, copy that cell until you have more numbers than needed. Now you need to filter out the duplicates. Select all your numbers, choose “Data” in the top menu, select “Filter” from the drop-down menu and then choose “Advanced filter.” In the dialog box, check the box by “Unique records only” and click “OK.” This will filter any duplicates. Now you have a random list of unique numbers. You don't have to remove the duplicates if your practice management software system will alert you of them when you enter a new patient.

Each time you work with the Excel file, the numbers will be regenerated, so you need to copy them to another column as values to prevent them from changing. Select your filtered numbers, choose “Edit” from the top menu and “Copy” from the drop-down menu. Now select an empty column and from the “Edit” menu select “Paste special.” Check the box next to “Values” and click “OK.” This will paste the value of the numbers instead of the formulas used to generate them. Now you have a preserved list of unique random numbers that you can use as record numbers. Keep in mind the numbers you preserve will not match those in the column you copied and pasted from; as soon as you copy the original numbers, a new list will be generated.

* Denotes member of FP Assist, the AAFP's online clearinghouse for consultants and attorneys.


Copyright © 2005 by the American Academy of Family Physicians.
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