Re: Re: help! how to opt out of Medicare and manage conflicting instructions?

[Guest guest]

,I'm in CA and have been opted out since 2006.  I went through the same thing you are going through.  I went back and forth with them (although never got anyone to laugh, good job!).

Basically, you have to be enrolled in Medicare before you can opt out.  If you did a residency in the US, it is almost guaranteed you were enrolled then.  I had called many times before I got my call escalated to a high level employee who said they had never had a doctor that did not enroll in Medicare when they opened their practice (of course, not true). 

, unless I'm reading incorrectly, I don't think means contracts with patients but rather with CMS.

I ended up submitted my letter several times, sent certified or some kind of delivery receipt; never heard back, but let it at that.  On resubmissions, I usually get a letter saying I am opted out.  I'm actually due to re-opt-out (what a funny world), but it was falling to the end of my " TO DO " list because of the absurdity.

Next will be when your patients try to get reimbursed from secondary insurance but need to have the EOB from Medicare (which they and you aren't allowed to bill).  Most places end up accepting a copy of the opt-out letter that you get back from Medicare, but of coures, that assumes you eventually get that.

On some level, this is of course, confirming that you are making the right decision to opt out.   As we often say, you really can't make this stuff up.  But it is healthy to not take it too seriously or you'll drive yourself crazy! 

What part of CA are you in?  I'm adjacent to Newport Beach on the UCI campus.

Sharon

Sharon McCoy MDRenaissance Family Medicine10 McClintock Court; Irvine, CA  92617PH: (949)387-5504   Fax: (949)281-2197  Toll free phone/fax:  www.SharonMD.com

 

, you should send a copy of this post to your state senator, the director of CMS, and the director at Palmetto. This kind of garbage is why we are all going to burn out and retire early, and probably die young, as well. And the irony of it all is that you have to negotiate this mess so that you can NOT participate with Medicare!!!---Sharlene

>

> Has anyone opted out of Medicare this summer, especially via Palmetto GBA

> which is California's Medicare carrier?

>

> I wanted to opt-out effective 7/1/12; I sent in the opt-out affadavit in

> late May, but now have gotten stuck because in early June they wrote to me

> requesting a signed contract with beneficiary...but of course I had no

> patients, since I had not yet opted-out and in fact had been planning to

> start trying to see patients in August.

>

> On the phone in June I was told ok to send a sample contract unsigned by

> beneficiary, however that was then rejected. They tell me on the phone my

> opt-out was denied, although I've never received the letter they claim they

> sent.

>

> Every time I call, someone tells me something else. One person said of

> course I wouldn't be able to provide a contract signed by beneficiary and

> that the analyst was wrong to deny me, so he " escalated " my case and said

> it should be resolved in 7-10 days.

>

> When I called the enrollment center 2 weeks later, the person began to

> giggle on the phone and then apologized and said she's sorry but this is a

> weird catch-22 and they just don't know what to tell doctors about it,

> because you aren't allowed to see patients before you opt-out, but you

> can't opt out without a signed contract.

>

> The next person (today) told me you are supposed to provide a signed

> contract within 10 days of the affadavit. She did not know how I am

> supposed to do that when they also require you to submit your affadavit 30

> days before the start of the quarter. She thinks I will probably have to

> try to opt-out again, although it's unclear how to do that successfully.

>

> Meanwhile the case is still " escalated, " which apparently means some

> department in which you can never call them.

>

> Today I took a good look at the regulations. One section does say " In order

> for a private contract with a beneficiary to be effective, the

> physician/practitioner must file an affidavit with all Medicare carriers to

> which the physician/practitioner would submit claims, advising that the

> physician/practitioner has opted out of Medicare. The affidavit must be

> filed within 10 days of entering into the first private contract with a

> Medicare beneficiary. "

>

> Another section says " Participating physicians or practitioners may sign

> private contracts only after the effective date of affidavits filed in

> accordance with §40.9 "

>

> And then of course there is this " Participating physicians and

> practitioners may opt out if they file an affidavit that meets the criteria

> and which is received by the carrier at least 30 days before the first day

> of the next calendar quarter showing an effective date of the first day in

> that quarter (i.e., January 1, April 1, July 1,October 1). "

>

>

> Does anyone have suggestions?? If I get a beneficiary to sign a contract

> this week and send it to them, will that reach the escalation people and

> resolve the issue?

>

> thanks for any suggestions,

> leslie

> --

> Kernisan, MD MPH

> Geriatrics

>

[Guest guest]

thank you all for the support and encouragement.Steve, did you send in the signed contract with your opt-out affadavit, 30 days before July 1? At this point I'm starting to think I'm unlikely to turn this around and be opted-out effective July, so I may be forced to take a small sabbatical until October...but I would at least like to figure out how to get it right for October.

Sharon, I was previously enrolled in Medicare because I worked at an FQHC for older adults for 2 years. I'm in San Francisco. I left my previous job because among other things they wanted me to be scheduled for 10-11 patients per half day...apparently there is no federal productivity standard for geriatricians, so if I see nothing but frail elders, I either run way behind or have terrible productivity, or sometimes both!

I have indeed been thinking of writing letters regarding this circus, I'm only sorry I didn't think to record all my calls with them.FWIW, several people told me at Palmetto that this requirement for a signed contract with beneficiary is new, or perhaps just being newly enforced. When I myself read the Medicare regulations, I don't see anything requiring one to file a copy of the contract, but it does say it needs to be furnished to CMS on request.

sigh. deep breaths!lk-- Kernisan, MD MPHGeriatrics

,I'm in CA and have been opted out since 2006.  I went through the same thing you are going through.  I went back and forth with them (although never got anyone to laugh, good job!).

Basically, you have to be enrolled in Medicare before you can opt out.  If you did a residency in the US, it is almost guaranteed you were enrolled then.  I had called many times before I got my call escalated to a high level employee who said they had never had a doctor that did not enroll in Medicare when they opened their practice (of course, not true). 

, unless I'm reading incorrectly, I don't think means contracts with patients but rather with CMS.

I ended up submitted my letter several times, sent certified or some kind of delivery receipt; never heard back, but let it at that.  On resubmissions, I usually get a letter saying I am opted out.  I'm actually due to re-opt-out (what a funny world), but it was falling to the end of my " TO DO " list because of the absurdity.

Next will be when your patients try to get reimbursed from secondary insurance but need to have the EOB from Medicare (which they and you aren't allowed to bill).  Most places end up accepting a copy of the opt-out letter that you get back from Medicare, but of coures, that assumes you eventually get that.

On some level, this is of course, confirming that you are making the right decision to opt out.   As we often say, you really can't make this stuff up.  But it is healthy to not take it too seriously or you'll drive yourself crazy! 

What part of CA are you in?  I'm adjacent to Newport Beach on the UCI campus.

Sharon

Sharon McCoy MDRenaissance Family Medicine10 McClintock Court; Irvine, CA  92617PH: (949)387-5504   Fax: (949)281-2197  Toll free phone/fax: 

www.SharonMD.com

 

, you should send a copy of this post to your state senator, the director of CMS, and the director at Palmetto. This kind of garbage is why we are all going to burn out and retire early, and probably die young, as well. And the irony of it all is that you have to negotiate this mess so that you can NOT participate with Medicare!!!---Sharlene

>

> Has anyone opted out of Medicare this summer, especially via Palmetto GBA

> which is California's Medicare carrier?

>

> I wanted to opt-out effective 7/1/12; I sent in the opt-out affadavit in

> late May, but now have gotten stuck because in early June they wrote to me

> requesting a signed contract with beneficiary...but of course I had no

> patients, since I had not yet opted-out and in fact had been planning to

> start trying to see patients in August.

>

> On the phone in June I was told ok to send a sample contract unsigned by

> beneficiary, however that was then rejected. They tell me on the phone my

> opt-out was denied, although I've never received the letter they claim they

> sent.

>

> Every time I call, someone tells me something else. One person said of

> course I wouldn't be able to provide a contract signed by beneficiary and

> that the analyst was wrong to deny me, so he " escalated " my case and said

> it should be resolved in 7-10 days.

>

> When I called the enrollment center 2 weeks later, the person began to

> giggle on the phone and then apologized and said she's sorry but this is a

> weird catch-22 and they just don't know what to tell doctors about it,

> because you aren't allowed to see patients before you opt-out, but you

> can't opt out without a signed contract.

>

> The next person (today) told me you are supposed to provide a signed

> contract within 10 days of the affadavit. She did not know how I am

> supposed to do that when they also require you to submit your affadavit 30

> days before the start of the quarter. She thinks I will probably have to

> try to opt-out again, although it's unclear how to do that successfully.

>

> Meanwhile the case is still " escalated, " which apparently means some

> department in which you can never call them.

>

> Today I took a good look at the regulations. One section does say " In order

> for a private contract with a beneficiary to be effective, the

> physician/practitioner must file an affidavit with all Medicare carriers to

> which the physician/practitioner would submit claims, advising that the

> physician/practitioner has opted out of Medicare. The affidavit must be

> filed within 10 days of entering into the first private contract with a

> Medicare beneficiary. "

>

> Another section says " Participating physicians or practitioners may sign

> private contracts only after the effective date of affidavits filed in

> accordance with §40.9 "

>

> And then of course there is this " Participating physicians and

> practitioners may opt out if they file an affidavit that meets the criteria

> and which is received by the carrier at least 30 days before the first day

> of the next calendar quarter showing an effective date of the first day in

> that quarter (i.e., January 1, April 1, July 1,October 1). "

>

>

> Does anyone have suggestions?? If I get a beneficiary to sign a contract

> this week and send it to them, will that reach the escalation people and

> resolve the issue?

>

> thanks for any suggestions,

> leslie

> --

> Kernisan, MD MPH

> Geriatrics

>

[Guest guest]

Thought the group might be interested in the latest twist in my saga.At the end of last week, I faxed my carrier (Palmetto) a contract signed by me and a family friend who happens to be a Medicare beneficiary. I included a cover letter explaining my situation (that someone by phone initially said ok to send a contract signed by just me, etc), but also included a quote from the Medicare regulations 

“Participating physicians or practitioners may sign

private contracts only after the effective date of affidavits filed in

accordance with §40.9.”And I pointed out that I'd been asked to send this before my effective opt-out date.Now I have found a voicemail from the head of the escalation department, asking me to call him!

we shall see what he says, i'll call tomorrow!leslie-- Kernisan, MD MPHGeriatrics

yes, they wrote to me in June requesting the sample contract, but the problem is that I sent one that was not signed by a beneficiary...after I called them and they told me by phone that that was ok, of course.

i now have one signed by a beneficiary, so will send in and see what happens. if rejected, then I will just have to aim for October, and perhaps use my unexpected spare time to mail letters to CMS, regional center, etc.

it is truly kafka-esque!thxs,leslie-- Kernisan, MD MPHGeriatrics

:

I sent in my opt-out affidavit in May.

I had a few issues holding me back, one being that I moved my office and that had to be straightened out before I could opt-out.

They, being Novitas, the administrator in my area, actually called me, twice in one week, to get both the address change and the opt-out concluded successfully. It helped that I had sent in a cover letter with the application stating how this was my third attempt and hoping this time I would be charmed.

The previous administrator was a major problem with lack of communication.

As for the sample contract, I believe they asked me for that in June, and accepted it, as my affidavit to opt out occurred in May, more than the month required.

Steve

stown.

> >> >

> >> > Has anyone opted out of Medicare this summer, especially via Palmetto

> >> GBA

> >> > which is California's Medicare carrier?

> >> >

> >> > I wanted to opt-out effective 7/1/12; I sent in the opt-out affadavit in

> >> > late May, but now have gotten stuck because in early June they wrote to

> >> me

> >> > requesting a signed contract with beneficiary...but of course I had no

> >> > patients, since I had not yet opted-out and in fact had been planning to

> >> > start trying to see patients in August.

> >> >

> >> > On the phone in June I was told ok to send a sample contract unsigned by

> >> > beneficiary, however that was then rejected. They tell me on the phone

> >> my

> >> > opt-out was denied, although I've never received the letter they claim

> >> they

> >> > sent.

> >> >

> >> > Every time I call, someone tells me something else. One person said of

> >> > course I wouldn't be able to provide a contract signed by beneficiary

> >> and

> >> > that the analyst was wrong to deny me, so he " escalated " my case and

> >> said

> >> > it should be resolved in 7-10 days.

> >> >

> >> > When I called the enrollment center 2 weeks later, the person began to

> >> > giggle on the phone and then apologized and said she's sorry but this

> >> is a

> >> > weird catch-22 and they just don't know what to tell doctors about it,

> >> > because you aren't allowed to see patients before you opt-out, but you

> >> > can't opt out without a signed contract.

> >> >

> >> > The next person (today) told me you are supposed to provide a signed

> >> > contract within 10 days of the affadavit. She did not know how I am

> >> > supposed to do that when they also require you to submit your affadavit

> >> 30

> >> > days before the start of the quarter. She thinks I will probably have to

> >> > try to opt-out again, although it's unclear how to do that successfully.

> >> >

> >> > Meanwhile the case is still " escalated, " which apparently means some

> >> > department in which you can never call them.

> >> >

> >> > Today I took a good look at the regulations. One section does say " In

> >> order

> >> > for a private contract with a beneficiary to be effective, the

> >> > physician/practitioner must file an affidavit with all Medicare

> >> carriers to

> >> > which the physician/practitioner would submit claims, advising that the

> >> > physician/practitioner has opted out of Medicare. The affidavit must be

> >> > filed within 10 days of entering into the first private contract with a

> >> > Medicare beneficiary. "

> >> >

> >> > Another section says " Participating physicians or practitioners may sign

> >> > private contracts only after the effective date of affidavits filed in

> >> > accordance with §40.9 "

> >> >

> >> > And then of course there is this " Participating physicians and

> >> > practitioners may opt out if they file an affidavit that meets the

> >> criteria

> >> > and which is received by the carrier at least 30 days before the first

> >> day

> >> > of the next calendar quarter showing an effective date of the first day

> >> in

> >> > that quarter (i.e., January 1, April 1, July 1,October 1). "

> >> >

> >> >

> >> > Does anyone have suggestions?? If I get a beneficiary to sign a contract

> >> > this week and send it to them, will that reach the escalation people and

> >> > resolve the issue?

> >> >

> >> > thanks for any suggestions,

> >> > leslie

> >> > --

> >> > Kernisan, MD MPH

> >> > Geriatrics

> >> >

> >>

> >>

> >

> >

> >

>

------------------------------------

[Guest guest]

Yup, I generally do it also and will again; it's just easy to get frustrated when it seems to be so silly.

I'll behave myself!SharonSharon McCoy MD

Renaissance Family Medicine10 McClintock Court; Irvine, CA  92617PH: (949)387-5504   Fax: (949)281-2197  Toll free phone/fax:  www.SharonMD.com

 

Fascinating, ! I can't wait to hear!---Sharlene

> >> > >> >

> >> > >> > Has anyone opted out of Medicare this summer, especially via

> >> Palmetto

> >> > >> GBA

> >> > >> > which is California's Medicare carrier?

> >> > >> >

> >> > >> > I wanted to opt-out effective 7/1/12; I sent in the opt-out

> >> affadavit in

> >> > >> > late May, but now have gotten stuck because in early June they

> >> wrote to

> >> > >> me

> >> > >> > requesting a signed contract with beneficiary...but of course I

> >> had no

> >> > >> > patients, since I had not yet opted-out and in fact had been

> >> planning to

> >> > >> > start trying to see patients in August.

> >> > >> >

> >> > >> > On the phone in June I was told ok to send a sample contract

> >> unsigned by

> >> > >> > beneficiary, however that was then rejected. They tell me on the

> >> phone

> >> > >> my

> >> > >> > opt-out was denied, although I've never received the letter they

> >> claim

> >> > >> they

> >> > >> > sent.

> >> > >> >

> >> > >> > Every time I call, someone tells me something else. One person

> >> said of

> >> > >> > course I wouldn't be able to provide a contract signed by

> >> beneficiary

> >> > >> and

> >> > >> > that the analyst was wrong to deny me, so he " escalated " my case

> >> and

> >> > >> said

> >> > >> > it should be resolved in 7-10 days.

> >> > >> >

> >> > >> > When I called the enrollment center 2 weeks later, the person

> >> began to

> >> > >> > giggle on the phone and then apologized and said she's sorry but

> >> this

> >> > >> is a

> >> > >> > weird catch-22 and they just don't know what to tell doctors about

> >> it,

> >> > >> > because you aren't allowed to see patients before you opt-out, but

> >> you

> >> > >> > can't opt out without a signed contract.

> >> > >> >

> >> > >> > The next person (today) told me you are supposed to provide a

> >> signed

> >> > >> > contract within 10 days of the affadavit. She did not know how I am

> >> > >> > supposed to do that when they also require you to submit your

> >> affadavit

> >> > >> 30

> >> > >> > days before the start of the quarter. She thinks I will probably

> >> have to

> >> > >> > try to opt-out again, although it's unclear how to do that

> >> successfully.

> >> > >> >

> >> > >> > Meanwhile the case is still " escalated, " which apparently means

> >> some

> >> > >> > department in which you can never call them.

> >> > >> >

> >> > >> > Today I took a good look at the regulations. One section does say

> >> " In

> >> > >> order

> >> > >> > for a private contract with a beneficiary to be effective, the

> >> > >> > physician/practitioner must file an affidavit with all Medicare

> >> > >> carriers to

> >> > >> > which the physician/practitioner would submit claims, advising

> >> that the

> >> > >> > physician/practitioner has opted out of Medicare. The affidavit

> >> must be

> >> > >> > filed within 10 days of entering into the first private contract

> >> with a

> >> > >> > Medicare beneficiary. "

> >> > >> >

> >> > >> > Another section says " Participating physicians or practitioners

> >> may sign

> >> > >> > private contracts only after the effective date of affidavits

> >> filed in

> >> > >> > accordance with §40.9 "

> >> > >> >

> >> > >> > And then of course there is this " Participating physicians and

> >> > >> > practitioners may opt out if they file an affidavit that meets the

> >> > >> criteria

> >> > >> > and which is received by the carrier at least 30 days before the

> >> first

> >> > >> day

> >> > >> > of the next calendar quarter showing an effective date of the

> >> first day

> >> > >> in

> >> > >> > that quarter (i.e., January 1, April 1, July 1,October 1). "

> >> > >> >

> >> > >> >

> >> > >> > Does anyone have suggestions?? If I get a beneficiary to sign a

> >> contract

> >> > >> > this week and send it to them, will that reach the escalation

> >> people and

> >> > >> > resolve the issue?

> >> > >> >

> >> > >> > thanks for any suggestions,

> >> > >> > leslie

> >> > >> > --

> >> > >> > Kernisan, MD MPH

> >> > >> > Geriatrics

> >> > >> >

> >> > >>

> >> > >>

> >> > >

> >> > >

> >> > >

> >> >

> >>

> >>

> >>

> >>

> >> ------------------------------------

> >>

> >>

[Guest guest]

well, my conversation with the Head of Escalation at Palmetto was not nearly as exciting as I thought it would be. He doesn't seem to think they've done anything wrong, and I decided to not get into it.

He says they do need to have a signed contract with a beneficiary. He also says that your effective opt-out date is whenever they decide it is (i.e. the date you sign your affadavit), not at the start of the quarter, although you do have to give them notice 30 days before the quarter starts. 

He recommended I send in a new opt-out affadavit, along with another copy of my signed beneficiary contract. So I have done that and we'll see what happens.If anyone else is trying to opt-out in California, I suppose you could try including a signed beneficiary contract, and see if that gets you through faster.

-- Kernisan, MD MPHGeriatrics

Fascinating, !  I can't wait to hear!---Sharlene

> >> > >> >

> >> > >> > Has anyone opted out of Medicare this summer, especially via

> >> Palmetto

> >> > >> GBA

> >> > >> > which is California's Medicare carrier?

> >> > >> >

> >> > >> > I wanted to opt-out effective 7/1/12; I sent in the opt-out

> >> affadavit in

> >> > >> > late May, but now have gotten stuck because in early June they

> >> wrote to

> >> > >> me

> >> > >> > requesting a signed contract with beneficiary...but of course I

> >> had no

> >> > >> > patients, since I had not yet opted-out and in fact had been

> >> planning to

> >> > >> > start trying to see patients in August.

> >> > >> >

> >> > >> > On the phone in June I was told ok to send a sample contract

> >> unsigned by

> >> > >> > beneficiary, however that was then rejected. They tell me on the

> >> phone

> >> > >> my

> >> > >> > opt-out was denied, although I've never received the letter they

> >> claim

> >> > >> they

> >> > >> > sent.

> >> > >> >

> >> > >> > Every time I call, someone tells me something else. One person

> >> said of

> >> > >> > course I wouldn't be able to provide a contract signed by

> >> beneficiary

> >> > >> and

> >> > >> > that the analyst was wrong to deny me, so he " escalated " my case

> >> and

> >> > >> said

> >> > >> > it should be resolved in 7-10 days.

> >> > >> >

> >> > >> > When I called the enrollment center 2 weeks later, the person

> >> began to

> >> > >> > giggle on the phone and then apologized and said she's sorry but

> >> this

> >> > >> is a

> >> > >> > weird catch-22 and they just don't know what to tell doctors about

> >> it,

> >> > >> > because you aren't allowed to see patients before you opt-out, but

> >> you

> >> > >> > can't opt out without a signed contract.

> >> > >> >

> >> > >> > The next person (today) told me you are supposed to provide a

> >> signed

> >> > >> > contract within 10 days of the affadavit. She did not know how I am

> >> > >> > supposed to do that when they also require you to submit your

> >> affadavit

> >> > >> 30

> >> > >> > days before the start of the quarter. She thinks I will probably

> >> have to

> >> > >> > try to opt-out again, although it's unclear how to do that

> >> successfully.

> >> > >> >

> >> > >> > Meanwhile the case is still " escalated, " which apparently means

> >> some

> >> > >> > department in which you can never call them.

> >> > >> >

> >> > >> > Today I took a good look at the regulations. One section does say

> >> " In

> >> > >> order

> >> > >> > for a private contract with a beneficiary to be effective, the

> >> > >> > physician/practitioner must file an affidavit with all Medicare

> >> > >> carriers to

> >> > >> > which the physician/practitioner would submit claims, advising

> >> that the

> >> > >> > physician/practitioner has opted out of Medicare. The affidavit

> >> must be

> >> > >> > filed within 10 days of entering into the first private contract

> >> with a

> >> > >> > Medicare beneficiary. "

> >> > >> >

> >> > >> > Another section says " Participating physicians or practitioners

> >> may sign

> >> > >> > private contracts only after the effective date of affidavits

> >> filed in

> >> > >> > accordance with §40.9 "

> >> > >> >

> >> > >> > And then of course there is this " Participating physicians and

> >> > >> > practitioners may opt out if they file an affidavit that meets the

> >> > >> criteria

> >> > >> > and which is received by the carrier at least 30 days before the

> >> first

> >> > >> day

> >> > >> > of the next calendar quarter showing an effective date of the

> >> first day

> >> > >> in

> >> > >> > that quarter (i.e., January 1, April 1, July 1,October 1). "

> >> > >> >

> >> > >> >

> >> > >> > Does anyone have suggestions?? If I get a beneficiary to sign a

> >> contract

> >> > >> > this week and send it to them, will that reach the escalation

> >> people and

> >> > >> > resolve the issue?

> >> > >> >

> >> > >> > thanks for any suggestions,

> >> > >> > leslie

> >> > >> > --

> >> > >> > Kernisan, MD MPH

> >> > >> > Geriatrics

> >> > >> >

> >> > >>

> >> > >>

> >> > >

> >> > >

> >> > >

> >> >

> >>

> >>

> >>

> >>

> >> ------------------------------------

> >>

> >>