The BBA of 1997 permits a physician or practitioner to opt out of
Medicare and enter into private contracts with Medicare beneficiaries if
specific requirements are met. When a physician/practitioner "opts out"
of Medicare, no services provided by that individual will be covered or
reimbursed by Medicare. Nor will any reimbursement be issued to a
Medicare beneficiary for items or services provided by a
physician/practitioner who has opted out of the program.
If a physician/practitioner "opts out" of the Medicare program, it
must be for a two-year period. In addition, the physician/practitioner
cannot choose to opt out of Medicare for some Medicare beneficiaries but
not others; or for some services but not others.
Medicare Program Integrity Manual (Pub. 100-8), Chapter 10 (Provider
Enrollment), Section 11.7
http://www.cms.hhs.gov/manuals/downloads/pim83c10.pdf and Medicare
Benefit Policy Manual (Pub. 100-2)
http://www.cms.hhs.gov/manuals/Downloads/bp102c15.pdf , Chapter 15
(Covered Medical and Other Health Services), Section 40.9 provide
guidelines for the provider to “opt-out” of the Medicare Program. In
order to “opt-out”, a provider must submit a copy of an affidavit to:
Provider Enrollment
P.O. Box 34260
Little Rock, AR 72203
Refer to Chapter 15, Section 40.9
http://www.cms.hhs.gov/manuals/Downloads/bp102c15.pdf for key
information that must be contained in the affidavit.
