Part B Insider (Multispecialty) Coding Alert

Published on Mon Feb 02, 2015 PDF

If the thought of opting out of Medicare piques your interest, you might be in need of a quick opt-out primer. Fortunately, CMS provided one this week when the agency revised MLN Matters article SE 1311, which carefully outlines the requirements of practitioners who opt out of the program.

What it means: When you opt out of Medicare, “neither the physician nor the beneficiary submits the bill to Medicare for services rendered,” CMS says in the article. “Instead, the beneficiary pays the physician out-of-pocket and neither party is reimbursed by Medicare.”

The physician signs a private contract with the patient confirming that neither party can collect from Medicare for the services in question, and the doctor also has to send Medicare an affidavit announcing that he’s opting out of the system for two years.

You cannot sign opt-out contracts with some patients and then bill Medicare for other beneficiaries—once you opt out, you’ll have to sign private contracts that outline non-Medicare payment details for every patient. In addition, you can’t bill Medicare for specific services and use opt-out private contracts for others, the article says.

After the two year opt-out period ends, practitioners who want to stay opted out can renew their decisions with Medicare.

To read the entire MLN Matters article on this topic, visit www.cms.gov/Outreach-and-Education/Medicare-Learning-Network-MLN/MLNMattersArticles/Downloads/SE1311.pdf.