Paying a Visit to the Doctor: Current Financial Protections for Medicare Patients When Receiving Physician Services

KFF: Apr 07, 2014

With the recent decision to enact a 17th short-term “fix” to avert deep cuts in Medicare payments to physicians, Congress will likely return within the year to the question of whether and how to replace the widely-criticized formula that Medicare uses to calculate payments for physician services, called the Sustainable Growth Rate (SGR) system.1  For the most part, recent proposals on reforming the physician payment system leave intact current financial protections that shield beneficiaries from unexpected and confusing charges when they see physicians and practitioners.  These protections include the participating provider program, limitations on balance billing, and conditions on private contracting.  This issue brief describes these three protections, explains why they were enacted, and analyzes the implications of modifying them for beneficiaries, providers, and the Medicare program. Read More