Psychiatr News September 1, 2006
Volume 41, Number 17, page 13
© 2006 American Psychiatric Association
Psychiatric Practice & Managed Care APA Office of Healthcare Systems
and Financing
|
Remember To Renew Opt-Out Status
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. 
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