Practice Management Alert

Your practice has weighed the pros and cons of contracting with Medicare, and the final decision is to opt out and contract privately with patients. Now what? Traverse the CMS opt-out maze easily with this process outline from Deb Flanagan, recovery unit manager for Inland Cardiology Associates in Spokane, Wash.

1. Notify your patients that you are opting out of Medicare.

2. File an affidavit with your Medicare carriers stating that you are opting out. You can find samples of the form online at specialty association Web sites and even some Medicare carrier Web sites, such as Empire's at http://www.empiremedicare.com/provenroll/nyb/optout.htm.

The affidavit needs to state the date when you will opt out of Medicare and also outline the standard terms of the agreement (for example, the provider agrees not to charge Medicare for any service, and the provider agrees not to represent himself as a participating provider with Medicare).

3. Have a private contract with any Medicare Part B beneficiary before treating him. This contract should clearly state that the physician has opted out of the Medicare program but that your practice is not excluded from seeing Medicare patients. You must clearly list all services, and the patient must understand that he can go elsewhere to be treated by a participating Medicare provider.

4. Implement procedures within your office to ensure that you never file a Medicare claim and that you do not provide the information to your patient to file a Medicare claim. Two exceptions to this are emergency or urgent care, and providing covered services that Medicare would deem unnecessary.

5. Mark your calendar so that you can send in a new opt-out form every two years.

Note: If you are already a participating provider, CMS states, "To opt out of Medicare, a participating physician must first terminate his or her Medicare Part B participation agreement." In the past, you only had one time each year when Medicare allowed you to terminate Medicare participation. Recently, however, CMS has allowed termination on the following quarterly basis: Jan. 1, April 1, July 1, and Oct. 1.

Be aware that you must give your carrier 30-day prior notice by sending in the opt-out affidavit with an effective date of the beginning of the next quarter.