Medicare Opt Out: Part II

DME Marketing Florida

medicare opt outBy: Susan St. John

As noted in Opting Out of Medicare Part I, opting out of Medicare may be an option for some physicians and practitioners. After determining whether you are eligible for opt-out or if it is financially feasible, there are a few other considerations. Part I discussed the Private Contract a physician must enter into with each Medicare beneficiary he or she treats; here, we will address the opt-out affidavit and other nuances of opting out. Let’s get started!

The Medicare Opt Out Affidavit

Provisions in an Opt Out Affidavit are similar to provisions that must be included in the opted out physician’s or practitioner’s private contract with Medicare beneficiaries. The opt-out affidavit must state that the physician or practitioner will only provide services to Medicare beneficiaries with whom they have a written and signed private contract and that the physician or practitioner will not submit claims to Medicare on behalf of Medicare beneficiaries. Medicare does allow for an exception here, but that is only when an opted out physician or practitioner treats a Medicare beneficiary who is not under private contract, and that beneficiary presents with a medical emergency or urgent care problem. Keep in mind, that if a Medicare beneficiary presents with a medical emergency or urgent care problem, the physician or practitioner cannot require that patient to sign a private contract at that time.Continue reading

June 30th Deadline to e-Prescribe to Avoid Medicare Adjustment Penalty

June 30, 2012 is the deadline for submitting ten (10) Part B Fee for Service (FFS) claims to Medicare to avoid the 2013 Adjustment (penalty) of 1.5% against 2013 reimbursements.

Exception: if a provider submitted 25 e-prescribing events successfully in 2011, they have already met the reporting requirement to avoid the 2013 penalty. Otherwise, this upcoming June 30, 2012 deadline will apply. If you’ve started e-prescribing and are continuing to do so, do not stop at just 10 for this year to avoid the reduced reimbursement for 2013. This should be continually noted on all Medicare claims regardless to avoid any future penalties into the coming years as they will continue to require this as there will be a 2% reduction for year 2014 as well.