Medicare opt-out requires meticulous paperwork

Contract Language. By Steven M. Harris, AMNews contributor. Jan. 6, 2003.

CONTRACT LANGUAGE

A column examining the ins and outs of contract issues

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Last month's column addressed the impact on physicians who opt out of the Medicare program and requirements for execution of mandatory private contracts. This column will specifically address the requirements of the requisite opt-out affidavit and continue to explore the implications for physicians who decide to opt out of Medicare.

A physician must file an affidavit with all Medicare carriers to which he or she submits claims, or would submit claims if not for the opt-out, for a private contract with a beneficiary to be effective.

A valid affidavit for purposes of opting out of Medicare must be in writing, signed by the physician, and contain the physician's full name, address, telephone number, uniform provider identification number (if one has been assigned), or the physician's tax identification number.

The affidavit should state that during the opt-out period:

• Except for emergency or urgent care services, the physician will provide services to Medicare beneficiaries only through private contracts that meet specific criteria.
• The physician or his or her agent will not submit a claim to Medicare for any service furnished to a Medicare beneficiary.
• The physician understands that he or she may receive no direct or indirect Medicare payment for services that he or she furnishes to Medicare beneficiaries with whom he or she has privately contracted.
• The physician acknowledges that his or her services are not covered under Medicare and that no Medicare payment may be made to any entity for his or her services, directly or on a capitated basis.