The BBA of 1997 permits a physician or
practitioner to opt out of Medicare and enter into private contracts with
Medicare beneficiaries if specific requirements are met. When a
physician/practitioner "opts out" of Medicare, no services provided by that
individual will be covered or reimbursed by Medicare. Nor will any
reimbursement be issued to a Medicare beneficiary for items or services
provided by a physician/practitioner who has opted out of the program.
If a physician/practitioner "opts out" of the Medicare program, it must
be for a two-year period. In addition, the physician/practitioner cannot
choose to opt out of Medicare for some Medicare beneficiaries but not
others; or for some services but not others.
Medicare Program Integrity Manual (Pub. 100-8), Chapter 10 (Provider
Enrollment), Section 11.7
http://www.cms.hhs.gov/manuals/downloads/pim83c10.pdf and Medicare Benefit
Policy Manual (Pub. 100-2)
http://www.cms.hhs.gov/manuals/Downloads/bp102c15.pdf , Chapter 15 (Covered
Medical and Other Health Services), Section 40.9 provide guidelines for the
provider to “opt-out” of the Medicare Program. In order to “opt-out”, a provider
must submit a copy of an affidavit to:
Medicare Part B Provider Enrollment
P.O. Box 83860
Baton Rouge, LA 70884-3860
Refer to Chapter 15, Section 40.9
http://www.cms.hhs.gov/manuals/Downloads/bp102c15.pdf for key information
that must be contained in the affidavit.
