PRIVATE CONTRACTS BETWEEN MEDICARE BENEFICIARIES AND PHYSICIAN/PRACTITIONERS

According to section 4507 of the Balanced Budget Act of 1997, certain Medicare physicians and practitioners are permitted to "opt out" of Medicare for two years for all covered items and services that he or she furnishes to Medicare beneficiaries.

In a private contract, the Medicare beneficiary agrees to give up Medicare payment for services furnished by the physician or practitioner, and to pay the physician or practitioner without regard to any limits that would otherwise apply to what the physician or practitioner could charge.

To opt out of Medicare:

• Participating physicians must first terminate their Medicare Part B participation agreement.
• Participating providers are only permitted to opt out at the beginning of each calendar quarter. To do this, a provider must submit a valid affidavit at least 30 days before the first day of any quarter (January, April, July, or October).
  
  

  Send to:

  Provider Enrollment
  P.O. Box 3434
  Hingham, MA 02044

• Non-participating physicians and practitioners, on the other hand, may opt out at any time.
• The Opt-Out contract is for a two-year period -- from the date the physician or practitioner files and signs an affidavit notifying Medicare that he or she has opted out of Medicare.  After the two-year period is over, the physician or practitioner could elect to return to Medicare or to "opt out" again.
• Certain healthcare provider categories, however, cannot opt out of Medicare. These include chiropractors, doctors of oral surgery, physical therapists in independent practice, and occupational therapists in independent practice.

Complete Listing of Opt-Out Physicians

Quarterly Listings of Opt-Out Physicians

• April-June 2008
• January-March 2008
• October - December 2008
• July-September 2007
• April-June 2007
• January-March 2007
• October - December 2006
• July-September 2006
• April-June 2006
• January-March 2006