Medicare control

So how exactly does the government control the practice of medicine through the Medicare program? One way is by “allowing” or “not allowing” services. They of course don’t necessarily come out and say that “you can’t have that procedure.”  They just refuse to pay for it. So if a Medicare patient comes to me and has a lesion that is bothersome (but not obviously malignant) and the patient wants me to remove it, they must first sign an ABN (Advanced Beneficiary Notice). This is meant to inform the patient that Medicare will most likely not pay for the procedure so you are on your own for payment. When most procedures are relatively expensive–also determined by the government through the CMS office, (I’ll talk about that tomorrow) the patient usually bails and says no thank you. This of course, works exactly as planned and decreases the services that Medicare must pay for. That’s not so bad I guess if it is a trivial procedure or request but you would be surprised at just what isn’t covered. Especially when some of these patients are in a lot of pain from whatever needs to be addressed but isn’t under the procedures they will accept financial responsibility for. How many of you have thickened toe nails from a fungus that causes severe foot pain when you put on a pair of shoes? Not covered. How about that mole that sits right under the strap of your bra? Not covered. You get the picture. Tune in tomorrow for the CMS issue.