MACRA Makes Medicare Opt-Out Changes

Did you opt out of Medicare (by signing a valid opt-out affidavit) on or after June 16, 2015?

If so, under the Medicare Access and Reauthorization Act (MACRA), your opt-out will automatically renew every two years unless you cancel the renewal. You’ll do this by notifying, in writing at least 30 days before the start of the next opt-out period, all Medicare administrative contractors (MACs) with which you filed an affidavit. 

If you opted out before June 16, 2015, your opt-out will expire two years after the effective date of your signed affidavit. In this case, you must submit a renewal affidavit within 30 days after the current opt-out period expires to all contractors with which you would have filed claims absent the opt-out. Check your current status now; make sure your opt-out affidavit hasn’t expired. 

The Centers for Medicare & Medicaid Services has updated the Medicare Benefit Policy Manual, Chapter 15, Section 40, to reflect this change and related changes, effective Aug. 16. Among other updates are these (new language is in italics): 

  • Medicare will make payment for covered, medically necessary services that are ordered or certified by a physician/practitioner who has opted out of Medicare if the ordering or certifying physician/practitioner has acquired a National Provider Identifier (NPI), reports his/her Social Security Number, has a valid opt out affidavit on file with his or her MAC, is of a specialty that is eligible to order and certify and provided that the services are not furnished by another physician/practitioner who has also opted out. (Section 40.5)
  • In order for a private contract with a beneficiary to be effective, the physician/practitioner must be opted out of Medicare. The physician/practitioner’s initial 2-year opt-out period begins the date the affidavit meeting [Medicare requirements] is signed, provided the affidavit is filed within 10 days after he or she signs his or her first private contract with a Medicare beneficiary. (Section 40.8)  
  • When a 2-year opt-out period ends, the physician/practitioner must enter into new private contracts with each beneficiary for the new 2-year period. The new private contracts must state the expected or known effective date and the expected or known expiration date of the current 2-year opt-out period. (Section 40.8)

For more information, see MLN Matters No. MM9619

Use the TMA Medicare Opt-Out Calculator to help determine your desired Medicare participation status. You can find more Medicare and MACRA information and resources in the TMA Medicare  and MACRA resource centers. 

Published Aug. 8, 2016

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Last Updated On

December 08, 2016

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