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

Opt out physicians will 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.

Opt 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, such as service fees.

Opt 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 prior to 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 choose 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. Opt 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.