Topic:
PHYSICIANS; MEDICARE;
Location:
INSURANCE - HEALTH;

OLR Research Report


September 28, 2004

 

2004-R-0770

CONNECTICUT PHYSICIANS ACCEPTING MEDICARE ASSIGNMENT

By: Saul Spigel, Chief Analyst

You asked for the number of Connecticut physicians who accept Medicare assignment.

Approximately 7,750 doctors (including chiropractors and podiatrists) practicing in Connecticut accept Medicare assignment according to the Centers for Medicare and Medicaid Services' (CMS) directory of participating physicians (PhysicianSearch). This represents about 75% of the 10,000 physicians currently licensed by the state. But not all licensed physicians provide direct patient care (the Connecticut Medical Society, using American Medical Association numbers, estimated about 7,000 physicians provided directed care in Connecticut in 2003), so the doctors who accept assignment may represent more than 75% of those who provide direct patient care.

But the CMS number may not be entirely accurate. Our review of 50 internists and 36 family providers listed in the CMS directory as practicing in a single Hartford zip code revealed four duplications among internists and one overlap between the two practice areas.

A doctor who accepts Medicare assignment agrees to receive as payment-in-full only the amount Medicare approves as reasonable for the service provided. (Medicare pays its share directly to the physician, and the individual or his insurer is responsible for the co-payment.) Doctors who choose to accept assignment can opt (1) to accept it in all cases or (2) on a case-by-case basis. The CMS directory does not identify which option each listed physician has chosen. And assignment does not apply when physicians provide services under a Medicare HMO arrangement.

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