Maneuver the Medicare Opt-Out Process in Three Easy Steps

Medicare: You can find samples of the form online at specialty association Websites and even some Medicare carrier Websites.

If you've decided that 2011 is the year your practice's going to scrap Medicare, follow this plan to see to it that you do not miss any important components when you are boosting your no-Medicare plan.

Notify Medicare that you are opting out

First, file an affidavit with your Medicare contractors informing them that your physician is opting out. If you're already a participating provider, states CMS, “To opt out of Medicare, a participating doctor must first terminate his or her Medicare Part B participation pact."

Tool: You can find samples of the form online at specialty association Websites and even some Medicare carrier Websites. For example, you can get National Government Service's form at www.ngsmedicare.com/pdf/medicareoptoutaffidavit.pdf.

Create a patient contract

If your practice decided to opt out of Medicare, however your providers plan to see Medicare patients, you will need solid patient contracts. “The provider has to have a written ‘private contract' with each Medicare beneficiary to whom the provider provides any service, except in a life-threatening emergency.

This contract, among other things, inform your patients that you're no longer part of Medicare and therefore, neither they nor the provider will get any reimbursement from Medicare. You'll be able to treat patients with Medicare coverage just like before, however you won't bill Medicare for the services. In its place, you'll bill any secondary or supplementary insurance the patient may have, or bill the patient directly. For instance, Medigap insurance will not pay you money if you're opted out since Medigap pays only secondary to Medicare payment.

Point to remember: Medicare has various requirements for what it considers an acceptable private contract. Be wary that the contracts have to be made available to CMS upon request, even long after the two-year opt-out period expires.

Set up internal processes to avoid claim errors

Finally, implement procedures within your office to ensure that:

You never file a Medicare claim

You don't provide the info to your patient to file a Medicare claim

Rule breaker: Two exceptions to this are emergency or urgent care, and providing covered services that Medicare would consider unnecessary.

Do not miss: Set up reminder notices either electronically or on a paper calendar so that you know when the two-year optout period expires. If you decide to opt out again, you will need to fill out another affidavit.

For more on this, and for more medical coding updates, sign up for a medical coding guide like Supercoder!