Opting out of Medicare Electing to Order/Certify Items and Services to Medicare Beneficiaries

by  Chris Woolstenhulme, QCC, CMCS, CPC, CMRS
August 10th, 2015

Physicians and practitioners who do not wish to enroll in the Medicare program may “opt-out” of Medicare. This means that neither the physician, nor the beneficiary submits the bill to Medicare for services rendered. Instead, the beneficiary pays the physician out-of-pocket and neither party is reimbursed by Medicare. A private contract is signed between the physician and the beneficiary that states, that neither one can receive payment from Medicare for the services that were performed. The physician or practitioner must submit an affidavit to Medicare expressing his/her decision to opt-out of the program.

The following shows physicians and other practitioners who are permitted by statute to opt-out of the Medicare program:

Physicians who are:

• Doctors of medicine or osteopathy;
• Doctors of dental surgery or dental medicine;
• Doctors of podiatry; or
• Doctors of optometry; and
• Who are legally authorized to practice dentistry, podiatry, optometry, medicine, or surgery by the State in which such function or action is performed.

 Practitioners who are:

• Physician assistants;
• Nurse practitioners;
• Clinical nurse specialists;
• Certified registered nurse anesthetists;
• Certified nurse midwives;
• Clinical psychologists;
• Clinical social workers; or
• Registered dietitians or nutrition professionals; and
• Legally authorized to practice by the State and otherwise meet Medicare requirements.

 Filing an Affidavit to Opt-out

Physicians and non-physician practitioners who want to opt-out must file a written affidavit with Medicare in which they agree to opt-out of Medicare for a period of two years and to meet certain other criteria.

Read more here to decide if this is an option for you

References:

• Opting out of Medicare and/or Electing to Order and Certify Items and Services to Medicare Beneficiaries