Private Contracting with Medicare Beneficiaries Section 4507 BBA permitted, effective January 1, 1998, certain physicians and practitioners (under the limited definition for this purpose) to privately contract with Medicare beneficiaries if the physician or practitioner files an affidavit with Medicare opting out of Medicare for two years. You received information on this option in last year's fact sheet and from carriers via carrier bulletins throughout the year.
HCFA is issuing final regulations that will make some changes to the policies currently in place and which will be furnished to you in future carrier bulletins. The most important of these changes include the following:
· There will be a 90 day period after the effective date of the first opt out affidavit submitted by a physician or practitioner in which he or she may revoke the opt out and return to Medicare as if he or she had never opted out. To do so, he or she will need to file claims for all beneficiaries treated under the private contract and will need to refund any amounts in excess of the limiting charge (in the case of a nonparticipating physicians) or the allowed amount (in the case of a participating physician). We are also providing a one time 90 day period beginning on the effective date of the regulations for physicians and practitioners who opted out during 1998 to revoke the opt out as long as they meet these same criteria.
· There will be additional information to be included in the private contracts and the opt out affidavits that are signed or effective on the effective date of the regulations.
· The regulations will clarify that, while excluded physicians and practitioners may opt out, they will continue to be restricted by the terms of their exclusion during the opt-out period.
· The penalties for failing to maintain opt out will apply if a physician or practitioner who opts out fails to sign a private contract with a beneficiary in other than an emergency or urgent care situation, and
· Medicare payment may be made to a beneficiary in cases in which a physician or practitioner who has opted out of Medicare fails to sign a private contract with the beneficiary for services that were not emergency or urgent care services.
Your Medicare carrier will provide more specific information on the changes to policy made by these regulations. It is possible that these policy changes may be superseded by new legislation and, if so, your carrier will notify you as soon as possible.
