Contracts required for Medicare opt-out

Contract Language. By Steven M. Harris, AMNews contributor. Dec. 9, 2002.

CONTRACT LANGUAGE

A column examining the ins and outs of contract issues

SEE ARCHIVES

This column is the first of two articles with an overview of requirements imposed on doctors who elect to opt out of Medicare and will specifically focus on private contracts you sign with your Medicare-eligible patients.

What you should know first is that opting out of Medicare is an all-or-nothing deal. You're in or you're out. No in between.

The opt-out statute, born in the Balanced Budget Act of 1997, enables physicians to enter into one or more private contracts with Medicare beneficiaries to furnish items or services that would otherwise be covered by Medicare. You would then bill the patient privately for the provision of such services.

Physicians who are considering opting out of Medicare must recognize that opt-out physicians are not allowed to participate in Medicare during a two-year "opt-out period" beginning on the effective date that the requisite affidavit is filed with the carrier. Except for emergency or urgent care services, Medicare or a Medicare+Choice plan cannot make any payment to a physician who has opted out of Medicare or to any entity to which the physician has reassigned his or her right to receive payment for services.

You should also keep in mind that a group practice is not allowed to opt out with respect to the entire practice; rather, opt-out status must be separately maintained for each opt-out physician. An alternative to opting out would be to limit your acceptance of Medicare patients.

The Medicare opt-out provisions impose significant administrative responsibilities on physicians and practitioners who wish to avoid Medicare limiting charge rules and bill patients privately for services. [...]