Since 1998, physicians have been able to opt out of Medicare and instead care for Medicare patients under private contracts. Opting out requires physicians to file an opt-out affidavit with their local Medicare Part B carrier and to sign a private contract with each Medicare patient. Templates of both types of documents can be accessed on APA's Web site with a full explanation of the process at<www.psych.org/members/practpsych/optingoutofmedicare112701.cfm>.
The opt-out period is two years. During this time, neither the physician nor the beneficiary is permitted to file claims with Medicare for the physician's services. Some patients, however, may be asked to submit claims to Medicare by their secondary payers before they will pay their share. The Centers for Medicare and Medicaid Services (CMS) suggests that when a secondary payer has this requirement, patients should provide that payer with copies of the doctor's opt-out affidavit and the private contract they signed. If the insurer still demands that a claim be submitted to Medicare, CMS says that patients may submit the claim but note on it that their physician has opted out and that they understand that Medicare will not pay the claim. Even though the contract expressly states such claims should not be filed, says CMS, patients can do so without worry because CMS has no sanctions in place against patients who file a claim for care from a physician who has opted out.
The Managed Care Help Line has recently received a number of calls from APA members that make it clear that some secondary payers and Medicare carriers are tracking physicians' opt-out status. These APA members had opted out of Medicare but failed to renew their opt-out status when the two-year period expired.
Failure to renew opt-out status can create an administrative snarl. In one case, an APA member was told by the Medicare carrier's customer service representative that since he was not in the Medicare provider database, he did not have to take any action to continue his opt-out status, except for submitting an enrollment application for reinstatement.
This information was incorrect. If you wish to retain your opt-out status after two years, you must renew it by filing another affidavit with the appropriate Medicare carrier and by updating your private contracts with your Medicare patients. Otherwise, you are obligated to file claims for your patients with Medicare and to charge only the Medicare-allowed amount for the treatment you provide. ▪
