Hi, you may be wondering, what are opted out physicians? Opted out physicians chose not to participate in the Medicare program and are not bound by the rules and regulations. Opted-out physicians are also called non-participating physicians.

Opted out physicians can not be required to accept the Medicare-approved amount as payment in full for their services, which allows them to charge patients more than the Medicare-approved amount. And, they are not required to file Medicare claims for their services.

Opted out physicians can accept Medicare beneficiaries as patients and must enter into a private contract with the patient for their services. The private contract must state the terms of payment like the service fees.

Opted out physicians do not participate in the Medicare appeals process and are not required to follow the Medicare fee schedule. But, they are still required to follow state and federal laws like anti-discrimination laws and laws related to fraud and abuse. Opting out of Medicare is a voluntary decision. Opting out requires physicians to provide written notice to Medicare patients and their jurisdiction's Medicare Administrative Contractor (MAC). At least 30 days before the effective date of the opt-out, physicians must provide the notice. Every two years, physicians must renew opt out agreements.

So, opted out physicians chose not to participate in the Medicare program and are not bound by the rules and regulations. Physicians are not required to accept the Medicare-approved amount as full payment for services and can charge patients more than the Medicare-approved amount. Opted out physicians are not subject to the Medicare appeals process or required to follow the Medicare fee schedule. Physicians must follow state and federal laws. Opting out of Medicare is a voluntary decision that physicians make by providing written notice to their Medicare patients and to the Medicare Administrative Contractor.