Inpatient Facility Coding & Compliance Alert

Question: Our surgery practice has chosen to opt out of Medicare. I heard that there’s a change in how we do that, and wondered if you might have any information to help us out.

Tennessee Subscriber

Answer: You are correct that there has been a recent change in how you opt out of Medicare. According to the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA), any opt-out affidavit that you sign on or after June 16, 2015 will auto-renew every two years. In the past, you had to manually refile your opt-out authorization every two years — so if you plan to stay out of Medicare indefinitely, the new change will be quite welcome and will save you both time and paperwork.

If, however, you do not want to opt out of Medicare anymore after your current authorization expires, you’ll have to cancel the renewal “by notifying all Medicare Administrative Contractors (MACs) with which you filed an affidavit in writing at least 30 days prior to the start of the next opt-out period,” CMS says in its June 25 MLN Connects Provider eNews document.

Any opt-out affidavits that you filed before June 16, 2015 won’t auto-renew. Instead, you’ll file a renewal affidavit within 30 days of the current opt-out period expiration.

Note also that your opt-out physicians can still file claims with Medicare for emergent or urgent care of Medicare beneficiaries. You will need to develop administrative policies and procedures if you anticipate such services being provided.