Medical Assistants • Opting Out of Medicare • Billing for Flu Vaccine

Question: What is the legal scope of practice of medical assistants when it comes to renewing prescriptions?

Answer: A medical assistant cannot renew a prescription based on protocols. The Medical Board of California (MBC) believes this would constitute the unlawful practice of medicine. Medical assistants can, however, according to the MBC, call in routine refills that are exact and have no changes in the dosage levels. The refill must be documented in the patient’s chart as a standing order, patient specific. Medical assistants may not call in new prescriptions or any prescriptions that have changes.

Question: I am a physician at an outpatient clinic. I only see patients on a cash-paying basis. I do not contract with any healthcare plans, nor am I a participating provider in Medicare. Do I still need to take the formal step of “opting out” of Medicare even if I have never been a participating provider?

Answer: Yes, you must formally opt out of Medicare every two years by notifying them of your intent not to participate. The opt-out contract is for a two-year period from the date the physician files and signs an affidavit notifying Medicare that he or she has elected to “opt out.” After the two-year period is over, the physician could elect to become a participating provider during the provider enrollment period, or he or she may “opt out” again.

Question: If I am contracted with a non-Medicare insurance company, am I allowed to have patients sign a waiver stating that we do not bill insurance companies for a flu vaccine and have the patients pay out of pocket? Can I have the patients pay the amount and have them attempt to get reimbursed directly from their health plan?

Answer: Most health plans contractually prohibit billing patients for covered services, so, if you are contracted, be sure you are not violating such clauses. Flu vaccines are usually covered services. You can negotiate a new contracted rate for these services with the health plans you contract with. If you have any patients that you see who have coverage with a plan that you are not contracted with, you are more than welcome to charge the amount and accept cash for it, and have the patient bill their insurance company for reimbursement.