No. I am not contracted with Medicare. My office has stairs, and it must be ADA-compliant to be contracted with Medicare.

When providers opt out of Medicare, they choose not to participate in the program. This means they will not bill Medicare for services provided to Medicare beneficiaries. However, you can still treat Medicare beneficiaries as private fee-for-service patients.

Here's what you need to know:

• Private Payment: You will be responsible for paying the provider directly for their services.

• No Medicare Reimbursement: Medicare will not reimburse you for any services an opted-out provider. I require payment at the time of service.

• Potential for Higher Costs: Providers who opt out of Medicare may charge higher fees than those participating in the program. For more information about rates, refer to the Investment page.

No. I am not a contracted provider with New Hampshire Medicaid.

You can pay privately for appointments with a provider who has opted out of Medicaid, even if you have New Hampshire Medicaid insurance.

However, it's important to note that you cannot submit claims to Medicaid to reimburse for these services. You will be responsible for paying the fees out of pocket. Payment is collected at the time of the appointment.

Discussing the costs and payment options with a provider who has opted out of Medicaid before seeing them is crucial. For more information about rates, refer to the Investment page.

It's also advisable to check with your Medicaid insurance provider to understand the potential implications of seeking care outside the Medicaid network. Paying privately may impact eligibility at redetermination.

Remember to keep all receipts and records of payments for potential tax deductions or other financial considerations.

There are 4 key differences between an MD psychiatrist and a PMHNP (Psychiatric Mental Health Nurse Practitioner) related to their education, training, and scope of practice:

Education and Training:

• MD Psychiatrist: A psychiatrist is a medical doctor (MD or DO) who has completed medical school and a residency in psychiatry. This extensive training focuses on the biological, psychological, and social components of mental health.

• PMHNP: A PMHNP is a registered nurse who has completed advanced practice training, typically a master's or doctoral degree in psychiatric-mental health nursing. This training emphasizes nursing care and includes clinical practice in mental health settings.

Scope of Practice:

• MD Psychiatrist: Psychiatrists can diagnose mental health conditions, prescribe medications, and provide psychotherapy. They are trained to manage complex psychiatric conditions and can perform medical procedures related to mental health, such as electroconvulsive therapy (ECT).

• PMHNP: PMHNPs can also diagnose mental health conditions and prescribe medications, often working in collaboration with psychiatrists or independently, depending on state regulations. They focus on holistic care and may provide psychotherapy, but their scope can be more limited compared to psychiatrists in specific settings.

Prescriptive Authority:

• Both MD psychiatrists and PMHNPs have prescriptive authority, but the extent of this authority can vary by state for PMHNPs. Psychiatrists generally have full prescriptive authority across all states.

Approach to Care:

• MD Psychiatrist: Often focuses on a medical model of care, integrating pharmacological and psychotherapeutic treatments.

• PMHNP: Emphasizes a nursing model of care, which may include a stronger focus on patient education, counseling, and holistic approaches.

Both professionals play crucial roles in mental health care, and their collaboration can enhance patient outcomes by combining medical and nursing perspectives.

Reasons for PMHNP Referral to a Higher Level of Care:

1. Complexity of the Case: If a patient's condition is complex or requires specialized interventions beyond the PMHNP's scope of practice or expertise, they may refer the patient to a psychiatrist or another specialist.

2. Need for Intensive Treatment: Patients who require intensive treatment, such as inpatient care, electroconvulsive therapy (ECT), or other specialized procedures, may be referred to a psychiatrist or a facility that can provide these services.

3. Medication Management: When medication management becomes complex, such as treatment-resistant conditions or polypharmacy, a referral to a psychiatrist may be necessary for more specialized pharmacological management.

Referrals are made to ensure that patients receive the most appropriate and effective care for their mental health needs.