Federal Agency: Deadline to Opt Out of Medicare


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Topic Federal Agency: Deadline to Opt Out of Medicare
Background The carrier must receive the opt out affidavit at least by this date. According to CMS, “normally, physicians and practitioners are required to submit claims on behalf of beneficiaries for all items and services they provide for which Medicare payment may be made under Part B. They are not allowed to charge beneficiaries in excess of the limits on charges that apply to the item or service being furnished. However, a physician or practitioner may opt out of Medicare. A physician or practitioner who opts out is not required to submit claims on behalf of beneficiaries and also is excluded from limits on charges for Medicare-covered services. “ For participating physicians there are only certain times during the year they may opt out. These deadlines are 30 days prior to the 1st day of the quarter (1/1, 4/1, 7/1, 10/1).
Regulating Body OIG HHS
Compliance Date 9/12/2011
Consequences The physician’s/practitioner‘s attempt to opt out of Medicare is nullified and all of the private contracts between the physician/practitioner and Medicare beneficiaries for the two-year period covered by the attempted opt-out are deemed null and void. The physician/practitioner must submit claims to Medicare for all Medicare-covered items and services furnished to Medicare beneficiaries, including the items and services furnished under the nullified contracts. A non-participating physician/practitioner is subject to the limiting charge provision. For items or services paid under the physician fee schedule, the limiting charge is 115 percent of the approved amount for non-participating physicians or practitioners. A participating physician/practitioner is subject to the limitations on charges of the participation agreement the physician/practitioner signed. The practitioner may not reassign any claim except as provided in the IOM Pub. 100-04, Chapter 1, Sections 30.2.12 and 30.2.13. The physician/practitioner may neither bill nor collect an amount from the beneficiary except for applicable deductible and coinsurance amounts. The physician/practitioner may make another attempt to properly opt out at any time.
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