Page 26 - Medicare Benefit Policy Manual
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• A physician/practitioner may enter into one or more private contracts with
Medicare beneficiaries for the purpose of furnishing items or services that would
otherwise be covered by Medicare (provided the conditions in §40.1 are met).
• A physician/practitioner who enters into at least one private contract with a
Medicare beneficiary (under the conditions of §40.1) and who submits one or
more affidavits in accordance with §40.9, opts-out of Medicare unless the opt-out
is terminated early according to §40.35 or unless the physician/practitioner fails to
maintain opt-out. (See §40.11.)
• Valid opt-out affidavits signed on or after June 16, 2015, will automatically renew
every 2 years. If physicians and practitioners who file affidavits effective on or
after June 16, 2015, do not want their opt-out to automatically renew at the end of
a 2 year opt-out period, they may cancel the renewal by notifying all contractors
with which they filed an affidavit in writing at least 30 days prior to the start of
the next opt-out period. Valid opt-out affidavits signed before June 16, 2015, will
expire 2 years after the effective date of the opt-out. If physicians and
practitioners that filed affidavits effective before June 16, 2015, want to extend
their opt-out, they must submit a renewal affidavit within 30 days after the current
opt-out period expires to all contractors with which they would have filed claims
absent the opt-out.
• Both the private contracts described in the first paragraph of this section and the
physician’s or practitioner’s opt-out described in the second paragraph of this
section are null and void if the physician/practitioner fails to properly opt-out in
accordance with the conditions of these instructions.
• Both the private contracts described in the first paragraph of this section and the
physician’s or practitioner’s opt-out described in the second paragraph of this
section are null and void for the remainder of the opt-out period if the
physician/practitioner fails to remain in compliance with the conditions of these
instructions during the opt-out period.
• Services furnished under private contracts meeting the requirements of these
instructions are not covered services under Medicare, and no Medicare payment
will be made for such services either directly or indirectly.
40.3 - Effective Date of the Opt-Out Provision
(Rev. 1, 10-01-03)
B3-3044.3
A physician/practitioner may enter into a private contract with a beneficiary for services
furnished no earlier than January 1, 1998.
40.4 - Definition of Physician/Practitioner
(Rev. 62, Issued: 12-22-06, Effective: 11-13-06, Implementation: 04-02-07)