Important Medicare Billing Changes
Frequently Asked Questions

What is Changing?

Effective January 1, 2019, Institute for Progressive Medicine will no longer be able to bill Medicare PPO for therapies or services performed here in our office.  We will continue to bill Medicare PPO for our patients until December 31, 2018. For more information about this change, please read the questions and answers below. If you have any other questions about this important change to our insurance billing policy, please call us at (949) 600-5100 or write info@iprogressivemed.com.

Why is IPM discontinuing its billing relationship with Medicare?

It has been a very tough decision to cease our billing relationship with Medicare. During this time, we have continued to work diligently toward offering the highest quality medical care to everyone, while still meeting increasingly strict Medicare billing and reporting requirements. Additionally, many of our services are not covered by Medicare and cannot be billed to Medicare even by participating providers. For this reason, we have decided to discontinue our billing relationship with Medicare. This change enables us to continue to offer longer and more comprehensive ofce visits and the extensive complementary care that our doctors choose to provide to our patients.

Why is IPM discontinuing its billing relationship with Medicare?

It has been a very tough decision to cease our billing relationship with Medicare. During this time, we have continued to work diligently toward offering the highest quality medical care to everyone, while still meeting increasingly strict Medicare billing and reporting requirements. Additionally, many of our services are not covered by Medicare and cannot be billed to Medicare even by participating providers. For this reason, we have decided to discontinue our billing relationship with Medicare. This change enables us to continue to offer longer and more comprehensive ofce visits and the extensive complementary care that our doctors choose to provide to our patients.

When will this change occur?

IPM is currently a contracted provider for Medicare PPO until December 31, 2018. Beginning January 1, 2019 IPM will no longer be a provider for Medicare and we will no longer be able to bill Medicare for ofce visits and procedures received here in our practice. If you have an appointment scheduled with a doctor at IPM before the end of 2018, we will be able to bill Medicare PPO for you for covered services.

Are you still able to act as my primary care physician?

Yes, absolutely. All IPM doctors can act as primary care physicians for patients who have Medicare. IPM doctors will still be able to write prescriptions for pharmaceutical medications, laboratory testing and referrals. Because IPM will no longer be a contracted provider for Medicare PPO after December 31, 2018, we will no longer be able to bill Medicare for any services received in our facility. Most laboratory testing will continue to be drawn in our ofce and billed to Medicare by the lab that runs the testing.

I have an upcoming appointment with an IPM doctor, what should I do?

If you are a Medicare patient with a scheduled ofce visit on or before December 31, 2018, there will be no change to our billing policy and you will not need to make any changes. Starting January 1, 2019 all visits and services provided by IPM will be on a fee-for-service basis and payment will be due at the time of service. After December 31, 2018 IPM cash pricing will apply for all patients who previously had services billed to Medicare.

Will there be any discounts available for Medicare patients at IPM?

Yes, in 2019 IPM will begin offering a special 20% senior discount for some services to all patients over the age of 65. This discount will be good for ofce visits that would normally be covered under Medicare. IPM will also offer periodic discounts on many of our popular services, including hormone pellet therapy, IV therapies, and specialized joint injections.

What will be the cost for a returning office visit with an IPM physician in 2019?

After December 31, 2018, a discounted return visit with Dr. Sosin for seniors 65 and older will be $160 for up to 30 minutes. A discounted return visit with Dr. Wittenberg for seniors 65 and older will be $144 for up to 30 minutes. These prices include a special senior discount of 20% off our normal cash prices of $200 for Dr. Sosin and $180 for Dr. Wittenberg.*

Do you recommend any medical service payment plans?

Yes, we recommend Parasail and CareCredit to patients who need assistance with payment plans specifcally designed to help with medical expenses. Please visit Parasail.com or CareCredit.com for information on these useful services. Make sure to arrange payment plans prior to your scheduled ofce visit. Full payment will be due at the time of service.

What about my prescription medications?

IPM staff can rell most prescription requests for patients who have been in to see an IPM doctor within the last 12 months. Patients who have not been seen by a doctor at IPM for more than 12 months will be required to have a visit with the doctor before any new prescription may be written.

Will I still be able to get my medication covered by Medicare using a prescription from an IPM doctor?

Yes. Medication normally covered by Medicare will continue to be covered. You can still make an appointment with a doctor at IPM and receive prescriptions for medications. You will not need to change your pharmacy.

Will I still be able to have my laboratory testing billed to Medicare?

Yes. IPM staff will continue to offer excellent blood draw services here in our ofce. We will also continue to offer standard and specialized testing through LabCorp, Doctor’s Data, Genova and others that is billable to Medicare by those laboratories.

Will you still be able to offer referrals to the medical specialists that I need?

Yes. Our doctors have built extensive and lasting relationships with the very best surgeons, specialists and diagnosticians. We regularly refer patients in need of specialized procedures, evaluations or testing as well as physical therapy, chiropractic, acupuncture and other services. Most of the specialists we refer to are Medicare service providers.

Can you bill my office visit to Medicare?

If you have Medicare PPO, we will bill for covered ofce visits and services only for the dates of service up to December 31, 2018. Starting January 1, 2019, we will not be able to bill any services delivered at our practice to Medicare. This will only affect services physically delivered at our practice. Please be advised that payment is due at time of service. We accept cash, check, Visa, MasterCard, Discover, American Express and Care Credit.

I have a Medicare Advantage Plan. Can you still bill office visits and services for me?

After December 31, 2018 we will not be able to bill Medicare Advantage Plans, such as those offered through United Health Care, Aetna, and others.

Can I send a superbill into Medicare to request reimbursement for services I receive at IPM?

Unfortunately, when a practice withdraws from their billing relationship with Medicare, Medicare does not permit patients to send in their own super bill for reimbursement. Instead, Medicare requires patients to agree that they will not submit for reimbursement. This is a specific rule determined by Medicare contracting requirements, not set by IPM policy.

Unfortunately, I will need to find another doctor that accepts Medicare. What should I do?

Medicare offers an extensive list of contracted, participating providers called Physician Compare in all areas of the United States. To review this list, visit Medicare online at:

www.medicare.gov/physiciancompare/

You may also contact Medicare for more information using the telephone number on your Medicare card.

If you have any other questions about IPM services, pricing, or our relationship with Medicare,
please call reception Monday-Friday 8:00am-4:30pm at (949) 600-5100.

* Discounts and Pricing are subject to change, some restrictions may apply.