Changes in Opting Out of Medicare Procedure

Ann K. Breitinger, Esq.

Ann K. Breitinger, Esq., Health Care and Business Law

Opting out of Medicare became much easier this summer for physicians looking to make a big change in their practice structure.  Additionally, physicians already opted out of Medicare can cross one more piece of paperwork off their list.

Pursuant to the original opt-out rules, opted-out physicians were required to continually opt out of Medicare at the expiration of every two (2) year period.  This renewal of opt out status involved sending new affidavits to Medicare and re-contracting with Medicare beneficiaries.  This procedure of opt-out renewal every two (2) years proved to be a hassle and source of anxiety for many validly opted out physicians.

Participating physicians may properly opt-out of Medicare at the beginning of any calendar quarter.  Opt-out affidavits must be submitted to the proper Medicare Administrator at least thirty (30) days before the beginning of the selected calendar quarter.  Once a physician has opted out of Medicare, they may not reenter the Medicare program for at least two (2) years.

With the passage of the Medicare Access and CHIP Reauthorization Act of 2015, which was signed into law in mid-April 2015, a physician choosing to opt-out of Medicare now only is required to opt out once.  The opt-out will now have a permanent effect.  The permanent opt-out became available sixty (60) days after the enactment of the Medicare Access and CHIP Reauthorization Act of 2015, which was signed on April 17, 2015.  As such, opt-out affidavits, including renewals, filed after June 16, 2015 may be a permanent opt-out.

The decision to opt-out of Medicare is one of the most important decisions you will make in your practice.  There are many factors to consider when making this decision.  The following types physicians and other practitioners are permitted by statute to opt-out of the Medicare program:

Physicians who are:

o   Doctors of medicine or osteopathy;

o   Doctors of dental surgery or dental medicine;

o   Doctors of podiatry; or

o   Doctors of optometry; and

o   Who are legally authorized to practice dentistry, podiatry, optometry, medicine, or surgery by the State in which such function or action is performed.

Practitioners who are:

o   Physician assistants;

o   Nurse practitioners;

o   Clinical nurse specialists;

o   Certified registered nurse anesthetists;

o   Certified nurse midwives;

o   Clinical psychologists;

o   Clinical social workers; or

o   Registered dietitians or nutrition professionals; and

o   Legally authorized to practice by the State and otherwise meet Medicare requirements.

For more information, please contact a member of our Health Care services practice group to discuss if opting out of Medicare is a viable option for your practice.  To reach Ann Breitinger, please call 941.0411 or email abreitinger@blalockwalters.com.