Page 42 - Medicare Benefit Policy Manual

40.20 - Maintaining Information on Opt-Out Physicians
(Rev. 222, Issued: 05-13-16, Effective: 08-15-16, Implementation; 08-15-16)

The Medicare contractor must maintain information on the opt-out physicians or
practitioners. At a minimum, it must capture the name and TIN of the physician or
practitioner, the effective date of the opt-out affidavit, and the automatic 2-year renewal
date for affidavits filed on or after June 16, 2015. If the physician/practitioner cancels
opt-out (see §40.34), then the Medicare contractor must also maintain the
physician/practitioner’s opt-out end date or cancellation date. The Medicare contractor
may also include other provider-specific information it may need. If cost effective, it
may house this information on its provider file.

40.21 - Informing Medicare Managed Care Plans of the Identity of the
Opt-Out Physicians or Practitioners
(Rev. 222, Issued: 05-13-16, Effective: 08-15-16, Implementation; 08-15-16)

The Medicare contractor must develop data exchange mechanisms for furnishing
Medicare managed care plans in its service area with timely information on physicians
and practitioners who have opted out of Medicare. For example, it may wish to establish
an Internet website “Home Page” which houses all of the information on physicians or
practitioners who have opted out. It will need to negotiate appropriate opt-out
information exchange mechanisms with each managed care plan in its service area.

40.22 - Informing the National Supplier Clearinghouse (NSC) of the
Identity of the Opt-Out Physicians or Practitioners
(Rev. 160, Issued: 10-26-12, Effective: 01-28-13, Implementation: 01-28-13)

The Medicare contractor must notify the NSC directly with timely information on
physicians or practitioners who have opted out of Medicare. An Internet Web site
“Home Page” is not an acceptable means of notifying the NSC. The NSC’s address is as
follows:

National Supplier Clearinghouse
P.O. Box 100142
Columbia, SC 29202-3142

40.23 - Organizations That Furnish Physician or Practitioner Services
(Rev. 1, 10-01-03)
B3-3044.23

The opt-out applies to all items or services the physician or practitioner furnishes to
Medicare beneficiaries, regardless of the location where such items or services are
furnished.