BC Advantage - 2017 Issue 3
Opting Out of Medicare
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Article Overview
This article covers Medicare opt-out procedures for providers and practitioners, with emphasis on the relationship between PECOS enrollment, Medicare contractor filing, private contracting, and timing requirements. It is aimed at medical coders, billing staff, compliance teams, and provider enrollment personnel who need a broad understanding of how opt-out status affects patient billing and ordering of services. The discussion also notes which practitioner categories may or may not opt out and what information is typically included in an opt-out affidavit.
Why This Topic Matters
Medicare opt-out status can affect whether a provider may bill Medicare, enter private contracts, and order certain services for Medicare beneficiaries. Understanding the administrative requirements helps reduce billing and compliance errors.
Article Sections
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Opting Out of Medicare Overview
Introduces the trend toward Medicare opt-out and dis-enrollment from PECOS, and explains the general administrative and patient-impact considerations involved.
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Effect of PECOS Enrollment Status
Describes how enrollment status relates to ordering services and the patient’s financial responsibility when Medicare is not billed in the usual way.
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Opt-Out Affidavit and Private Contract Requirements
Summarizes the filing process, contractor notification, renewal timing, and the role of private contracts in the opt-out process.
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Who May Opt Out and Who Cannot
Lists practitioner categories addressed in the article as eligible or ineligible for opt-out status under Medicare rules.
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Affidavit Content and Filing Details
Reviews the types of identifying and administrative information that must be included in an opt-out affidavit and where it is filed.
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Effective Dates and Timing Rules
Covers the timing of opt-out effectiveness, including filing deadlines, contractor jurisdiction, and the interaction with participation agreements and enrollment records.
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Example and Additional Resources
Provides a reference to an example private contract and includes closing information about the source organization.
What You Will Learn
- How Medicare opt-out differs from simply being unenrolled in PECOS
- What types of administrative filing steps are associated with opt-out status
- Which broad practitioner groups are discussed as able or unable to opt out
- What general information an opt-out affidavit is expected to contain
- How timing and jurisdiction affect the opt-out process
Who Should Read This
- Medical billers
- Coders
- Provider enrollment staff
- Compliance teams
- Practice administrators
- Physicians and practitioners
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