Is it unethical for a doctor to refuse Medicaid and Medicare patients?

[SheilaT]

142. This has been a problem ever since Medicare started.

I have heard many doctors complain about the low reimbursement.

I know this from working as a registration clerk in a hospital: For a medicare patient, we have to do something called "code-scrubbing", meaning we have to check that when tests or procedures are ordered, the diagnosis needs to be one that indicates those tests are necessary. Sometimes we have to get the patient to sign and ABN, Advance Beneficiary Notice, which says that Medicare may not pay for the test or procedure, and if it doesn't we'll be billing them directly. If we don't get the ABN signed, and if Medicare does not pay, we cannot go after the patient for payment.

Now there are certain tests or procedures that will automatically generate the ABN. For instance, Medicare may only pay for one particular blood test three times a year, and when that patient shows up for the test, the system has no way of knowing the last time they had the test.