Opting Out --> Physician/Practitioner Who Has Never Enrolled in Medicare

May 23, 2008

Someone asked about what those who never signed up for Medicare in the first place have to do to opt out of Medicare.

See below

Locke, MD

40.13 - Physician/Practitioner Who Has Never Enrolled in Medicare

(Rev. 1, 10-01-03)

B3-3044.13

For a physician/practitioner who has never enrolled in the Medicare program and wishes

to opt out of Medicare, the carrier must provide the physician/practitioner with a Unique

Physician Identification Number (UPIN). It can get the full name, address, license

number, and tax identification number from this affidavit. All other data requirements

should be developed from other data sources (e.g., the American Medical Association,

State Licensing Board, etc.). The carrier must annotate its in-house provider file and

update the UPIN Registry that the physician/practitioner has opted out of the program.

The physician/practitioner must not receive payment during the opt-out period (except in

the case of emergency or urgent care services). If the carrier needs additional data

elements and cannot obtain that information from another source, it may contact the

physician/practitioner directly. It must notify the physician or practitioner that in order to

refer or order services for a Medicare patient, the physician or practitioner must have a

UPIN.

If an opt-out physician/practitioner provides emergency or urgent care service to a

beneficiary who has not signed a private contact with the physician or practitioner and the

physician/practitioner submits an assigned claim, the physician or practitioner must

complete Form CMS-855 and enroll in the Medicare program before receiving

reimbursement. Under a similar circumstance, if the physician or practitioner submits an

unassigned claim, the carrier must pay the beneficiary directly without requiring a

completed Form CMS-855. It may use the information from the affidavit to begin the

enrollment process.

Recommended Posts