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

[Guest guest]

,Sorry for your frustrating situation. I have been opted out of Medicare since 2008, but have never heard of this rule. When I submitted my opt-out papers, and resubmitted them to Palmetto last year, there was no requirement to submitted any signed private contracts. I have never been asked to send them one. I would be very interested in seeing where this new "rule" came from. Perhaps you can call someone at Medicare to see if there is such a rule? SetoSouth Pasadena, CA

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 MPHGeriatrics

[Guest guest]

I just opted out as of July, mostly due to the ridiculous revalidation process

along with the writing on the wall for private docs.

My in laws are on Medicare so I had them sign a private contract with me and

sent it in.

The private contract was pretty much cut and pasted from my Medicare

administrators website.

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]

, 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]

,I have had some luck a couple of times in the past by contacting my regional CMS center about problems that the intermediary was screwing up. In my situations, they have been able to clarify rules and direct the intermediary to change their practice. I don't know if they can help in this issue but its worth a shot. Here is a link to their contact info: http://www.cms.gov/About-CMS/Agency-Information/RegionalOffices/index.html?redirect=/regionaloffices/ There is a link (upper left) to the regional map of centers so you can find which one is yours and then return to this link and scroll to the bottom to find the link to your regional office.Carla

To: Sent: Wednesday, August 1, 2012 12:58 PM Subject: help! how to opt out of Medicare and manage conflicting instructions?

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 MPHGeriatrics

[Guest guest]

:

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]

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

> >> > >> >

> >> > >>

> >> > >>

> >> > >

> >> > >

> >> > >

> >> >

> >>

> >>

> >>

> >>

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

> >>

> >>