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Opting Out of Medicare Enrollment
You currently have jurisdiction selected, however this page only applies to these jurisdiction(s): .
To comply with Medicare law, providers treating a Medicare patient for Medicare-covered services must complete one of the following:
- Enroll in Medicare and submit claims
- Opt-out of Medicare, if eligible, and enter a private contract with the patient for those services
- Furnish for free Medicare covered services
- This applies to providers not enrolling or opting out of Medicare
Opting out of Medicare - Background
Effect of Reassignment When a Provider Opts Out of Medicare
Opt Out Providers and Emergency or Urgent Care Services
Opting Out of Medicare - Background
Under the Social Security Act Section 1802 (b), physicians or practitioners may opt out of Medicare. The physicians or practitioners enter a private contract with Medicare patients. Only individual providers may opt out of Medicare. Group practices and organizations may not opt out.
Opt out status applies to all items and services furnished to Medicare patients regardless of the service location. Medicare does not pay the medical professional or patient. The exceptions are services for emergency or urgent care situations.
When a physician or practitioner opts out of Medicare, they cannot choose to:
- Opt out for some patients and not others
- Opt out for some services and not others
Providers Eligible to Opt Out
The following physicians and practitioners are eligible to opt out of Medicare:
- Certified Nurse Midwife (CNM)
- Certified Registered Nurse Anesthetist (CRNA)
- Clinical Nurse Specialist (CNS)
- Clinical Psychologists
- Clinical Social Workers (CSW)
- Doctor of Dental Surgery (DDS)
- Doctor of Dental Medicine (DMD)
- Doctor of Medicine (MD)
- Doctor of Optometry (OD)
- Doctors of Osteopathy (DO)
- Doctors of Podiatric Medicine (DPM)
- Nurse Practitioner (NP)
- Physician Assistants (PA)
- Registered Dieticians and Nutrition Professionals
The following physicians and practitioners are not eligible to opt out of Medicare:
- Anesthesiologist Assistants
- Chiropractors
- Independent, non-clinical Psychologists
- Occupational Therapists in private practice
- Physical Therapists in private practice
- Speech Language Pathologists in private practice
CMS Internet-Only Manual (IOM) Publication 100-09, Medicare Program Integrity Manual, Chapter 10 - Medicare Enrollment , Section 10.6.12 A
Private Contracts
A private contract is a contract between a Medicare patient and a provider who has opted out of Medicare. The patient agrees to:
- Give up Medicare payment for services furnished by the provider
- Pay the provider without regard to any limits Medicare would otherwise apply to what the provider could charge
The private contract must:
- Be in writing
- Have print large enough to ensure the patient can read the contract
- State whether Medicare excludes the physician or practitioner under the Social Security Act Sections 1128, 1156, or 1892
- State the patient or their legal representative:
- Accepts payment responsibility for the medical services provided by the physician or practitioner.
- Understands Medicare limits do not apply to the physician or practitioner’s charge for items or services furnished.
- Agrees not to submit a claim to Medicare.
- Will not ask the physician or practitioner to submit a claim to Medicare.
- Understands Medicare does not pay for items or services furnished by the physician or practitioner Medicare would otherwise cover:
- If there was no private contract
- If the physician or practitioner sent a proper Medicare claim
- Enters the contract knowing they can obtain Medicare-covered items and services from medical professionals not opting out.
- Enters private contracts not compelled for Medicare-covered services furnished by medical professionals not opting out.
- Understands Medigap plans do not pay for items and services not paid for by Medicare.
- Understands other supplemental plans may elect not to pay for items and services not paid for by Medicare.
- State the expected or known effective or expiration date of the opt out period.
- Effective with affidavits signed after June 16, 2015, opt out providers will automatically renew every two-year period.
- Enter a new private contract for each opt out period.
- Contain signatures, prior to any services provided under the contract's terms, from
- The patient or their legal representative
- The physician or practitioner
Patients or their legal representatives:
- Enter into a contract with the provider, a time when they do not need emergency or urgent care services
- Receive a copy of the contract before furnishing items or services under the contract terms
The physician or practitioner must:
- Retain the contract with original signatures for the duration of the opt out period.
- Make the contract available to the Centers for Medicare & Medicaid Services (CMS) upon request.
The provider should not submit a copy of the private contract to WPS Government Health Administrators. The provider is responsible for keeping this information on file.
Medicare allows opt out physicians or practitioners to order or refer medically necessary services. The opt out physician or practitioner must have a National Provider Identifier (NPI). Medicare considers payment for the ordered or referred services when furnished by a provider not opting out. For example, if an opt out provider:
- Admits a patient to a hospital, Medicare considers paying the hospital for medically necessary care.
- Orders diagnostic tests a not opt out provider performs, that provider may submit a Medicare claim for those services.
Opt Out Affidavits
To opt out of Medicare, a provider must file a valid Opt Out Affidavit. File the affidavit no later than ten days after entering the first private contract with a Medicare patient.
Providers can use our Opt Out Affidavit form or create their own. If a provider chooses to create their own affidavit, it must meet criteria in the IOM. The IOM Publication 100-09, Medicare Program Integrity Manual, Chapter 10 - Medicare Enrollment , Section 10.6.12 B 5 contains the criteria.
Opt Out Timeframes
Effective Date for Non-Participating Providers
Non-participating providers can opt out at any time by filing a valid Opt Out Affidavit. The effective date is the date the provider and patient signed the affidavit meeting the Medicare requirements.
Effective Date for Participating Providers
Participating providers opt out by filing a valid Opt Out Affidavit to their Medicare Administrative Contractor (MAC). Their MAC must receive the affidavit at least 30 days before the first day of the next calendar quarter. The opt out period effective date is the first day in that quarter. This means one of the following dates:
- January 1st
- April 1st
- July 1st
- October 1st
Opt out providers may not provide services under private contracts with patients before the effective date of the affidavit.
The provider who opts outs of Medicare terminates their Medicare participation agreement on the opt out effective date. This occurs as they no longer agree to accept assignment on claims for all services furnished to Medicare patients. Medicare considers the provider non-participating for any emergency or urgent care services paid during the opt out period.
Opt Out of Medicare Enrollment Cancelation
Providers notify MACs at least 30 days prior to the start of the next two year opt out period. Providers are responsible for notifying all MACs they filed an Opt Out Affidavit with.
Early Termination of Opt Out of Medicare Enrollment
Once approved, the provider may terminate their opt out status within 90 days of the affidavit effective date. The provider must meet the following criteria:
- Not have previously opted out of Medicare.
- Notify MACs of the termination no later than 90 days after the opt out period effective date.
- Providers must notify all MACS they filed the affidavit with.
- Refund private contract patients all payment collected more than the:
- Medicare limiting charge in the case of physicians.
- The deductible and coinsurance in the case of practitioners.
- Notify all private contract patients of
- The decision to terminate opt out.
- The patient's right to have Medicare claims filed for services during the opt out effective and termination dates.
Reference: CMS IOM Publication 100-09, Medicare Program Integrity Manual, Chapter 10 - Medicare Enrollment , Section 10.6.12 C
Effect of Reassignment When a Provider Opts Out of Medicare
When providers opt out and reassign their Medicare benefits, no organization may receive payment for their services. The organization may no longer bill Medicare provider’s services to Medicare patients. The organization may bill and receive payment for service to the patient under the private contract. The group practice or organization may bill Medicare for other provider’s services not opting out of Medicare.
Opt Out Providers and Emergency or Urgent Care Services
To submit an assigned claim, the opt out provider would need to complete the enrollment process. This would not affect the provider’s opt out status for purposes of other services. This process is completed via one of the following:
- Internet-based Provider Enrollment, Chain, and Ownership System
- Form CMS 855I
For claim submission guidelines, see our Claims for Professionals Opting Out of Medicare resource.
Opt Out List
The list of providers currently opting out of Medicare are on the Opt Out Affidavits web page.
Once the web page opens:
- Select “View Data” to search the list
- Select “Download” to download a list
- Select “Access API” for programmatic access to the list
Opt Out Resources
Social Security Act Section 1802 (b)
Medicare Access and CHIP Reauthorization Action of 2015 (MACRA) Public Law No. 114-10 Section 106(a)
global-tags: Provider Enrollment,J8B,J5B,Opt Out
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Medicare Provider Enrollment
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(866) 234-7331
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USPS Mailing Address
WPS GHA
Medicare Provider Enrollment
P.O. Box 8248
Madison, WI 53708-8248
Overnight Delivery
WPS GHA
Medicare Provider Enrollment
1717 W. Broadway
Madison, WI 53713-1834
(866) 518-3285
7:00 AM - 5:00 PM CT, Monday - Friday
USPS Mailing Address
WPS GHA
Medicare Provider Enrollment
P.O. Box 8248
Madison, WI 53708-8248
Overnight Delivery
WPS GHA
Medicare Provider Enrollment
1717 W. Broadway
Madison, WI 53713-1834
(866) 234-7331
8:00 AM - 5:00 PM ET, Monday - Friday
USPS Mailing Address
WPS GHA
Medicare Provider Enrollment
P.O. Box 8248
Madison, WI 53708-8248
Overnight Delivery
WPS GHA
Medicare Provider Enrollment
1717 W. Broadway
Madison, WI 53713-1834
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