Does opting out of Medicare follow the physician?

The opting out of Medicare by a physician applies to all items or services the physician or practitioner furnishes to Medicare beneficiaries regardless of the location where such items or services are furnished. When a physician/practitioner opts out and is a member of a group practice or otherwise reassigns his rights to Medicare payment to an organization, the organization may no longer bill Medicare or be paid by Medicare for services that the physician or practitioner furnishes to Medicare beneficiaries.

However, if the physician or practitioner continues to grant the organization the right to bill and be paid for the services he furnishes to patients, the organization may bill and be paid by the beneficiary for the services provided under the private contract. The decision of a physician/practitioner to opt out of Medicare does not affect the ability of the group practice or organization to bill Medicare for the services of physicians and practitioners who have not opted out of Medicare. Corporations, partnerships or other organizations that bill and are paid by Medicare for the services of physicians or practitioners who are employees, partners or have other arrangements that meet the Medicare reassignment-of-payment rules cannot opt out because they are neither physicians nor practitioners. Of course, if every physician and practitioner within a corporation, partnership or other organization opts out, then such corporation, partnership or other organization would have, in effect, opted out.

About the Author

Reed Tinsley CPA

This article is written by Reed Tinsley, a Houston, TX-based CPA with over 30 years of experience advising physicians and medical practices across Texas and the United States. Reed holds certifications as a Certified Valuation Analyst (CVA), Certified Healthcare Business Consultant (CHBC), and Certified Financial Planner (CFP), specializing exclusively in the healthcare sector. He is a published author, nationally recognized speaker, and trusted advisor to physicians on accounting & tax, practice management, and financial planning. Schedule a Free Consultation.