Practice Management Alert

Before you opt out of Medicare, make sure you know how to enter into contracts with each of your Medicare patients, or you'll be setting your practice up for major compliance issues.

Follow this checklist of 15 patient contract must-haves straight from Medicare. You can find the exact CMS wording in the Medicare Benefit Policy Manual, Chapter 15, Transmittal 40.8 (rev. 1, 10-01-03).

According to CMS, the contract should:

-- Be in writing and in print large enough for the beneficiary to read the contract.

-- Identify whether the physician is excluded from Medicare.

-- State that the beneficiary agrees to accept full responsibility for payment.

-- State that the beneficiary understands that Medicare limits do not apply to what your practice is allowed to charge for services.

-- State that the beneficiary agrees not to submit a claim to Medicare or ask the physician to submit a claim to Medicare.

-- Ensure that the beneficiary understands that Medicare payment will not be made for any items or services the physician furnishes that Medicare would have covered if there was no private contract, and if you'd submitted a proper Medicare claim.

-- State that the beneficiary enters into the contract knowing that he has the right to obtain Medicare-covered items and services from physicians who have not opted out of Medicare.

-- Include the expected or known effective date and expected or known expiration date of the opt-out period.

-- State that the beneficiary understands that Medigap plans do not -- and that other supplemental plans may elect not to -- make payments for items and services Medicare doesn't reimburse.

-- Require the beneficiary's and the physician's signature.

-- Not be entered into by a beneficiary who requires emergency or urgent-care services.

-- Be provided to the beneficiary before the physician provides items or services under the contract's terms.

-- Be retained by the physician for the duration of the opt-out period.

-- Be made available to CMS upon request.

-- Be entered into for each opt-out period (every 2 years).

Note: You can view CMS's actual wording about contract requirements in the Medicare Benefit Policy Manual, Chapter 15, which you can read online at www.cms.hhs.gov/Manuals/downloads/bp102c15.pdf.