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Originally Posted by ansible90
Docs don't have to opt in to Medicare. Before I moved, my doc was not a Medicare doc, but she did accept Medicare Assignment. That means she accepted the Medicare-approved price for visits, procedures, etc. Looks like she will now have to file an opt-out form. My new doc is a Medicare doc.
I think this new opt-out refers only to Part D, but not sure.
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If a provider submits claims to Medicare they have "opted-in." There are 4 types of providers in the eyes of Medicare.
1. Participating - These providers have signed a contract with Medicare (opted-in), accept assignment, and accept the Medicare approved amount as payment in full.
2. Non-Participating/Accepts Assignment - These providers have opted-in by submitting the claim, and accept assignment.
3. Non-Participating//Not Accepting Assignment - These providers have opted-in by submitting the claim but can balance bill an additional 15% above the Medicare Fee Schedule rate, called Part B Excess Charges.
4. Opted-Out. The opt-out provision has been around for many years and before Part D.
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Provisions in the Balanced Budget Act of 1997 give physicians and their Medicare patients the freedom to privately contract to provide health care services outside the Medicare system. Private contracting decisions may not be made on a case-by-case or patient-by-patient basis, however. Once physicians have opted out of Medicare, they cannot submit claims to Medicare for any of their patients for a two-year period.
As of September 2013, among all U.S. physicians in clinical practice, less than 1 percent (4,863) have signed affidavits with Medicare indicating that they have “opted out” of the Medicare program.
Medicare does not reimburse either the physician or the Medicare patient for any services provided by physicians who have opted out of the Medicare program. Opt-out physicians must tell their Medicare patients that they have opted out of Medicare and provide them with a document stating that Medicare will not reimburse either the physician or the patient for any services furnished by opt-out physicians. Medicare patients must sign this document to signify their understanding of it.
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More info:
ProducersWeb - Health - Understanding Medicare Part B excess charges
Each Medicare Part B Claims Processor maintains a list of opt-out providers. You can search the VT opt-out list here (just enter the first letter of last name):
https://www.ngsmedicare.com/ngs/port...risdiction%20K