Opt-Out Clarification

On a regular basis, APA's Managed Care Help Line receives calls from psychiatrists thinking about opting out of Medicare so that they can see Medicare patients under private contracts. The information about opting out and the forms for completing an opt-out application and creating private contracts with Medicare patients are posted on APA's Web site at<www.psych.org/members/practpsych/optingoutofmedicare112701.cfm>.

Psychiatrists sometimes run into a problem with opting out because although they don't wish to see Medicare patients in their private practices, they may work at clinics where they provide care to Medicare patients as part of their employment. It is important to understand that even though the clinic may bill under its own number to Medicare and does not use the physician's UPIN, legally Medicare does not pay for treatment provided by a doctor who has opted out of the program. This is the official word that APA's Office of Healthcare Systems and Financing received from Fred Grabau, a health insurance specialist in the Centers for Medicare and Medicaid Services' Division of Technical Payment Policy. If you hear otherwise from colleagues, or even from your Medicare carrier, what you hear is incorrect.

If you have opted out of Medicare and want to continue your clinic work, you must make it clear to the clinic that you can see Medicare patients only under private contracts and that the patients will not be able to receive any reimbursement from Medicare.

For questions about opting out or Medicare in general, call APA's Help Line at (800) 357-7924. ▪