Organizations That Furnish Physician or Practitioner Services

Opt-out regulations apply to all items or service the physician or practitioner furnishes to Medicare beneficiaries, regardless of the location where such services are furnished.

When a physician or practitioner opts out and is a member of a group practice or otherwise reassigns 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.

If the physician or practitioner continues to grant the organization the right to bill and be paid for the services they furnish to patients, the organization may bill and be paid by the beneficiary for the services that are provided under the private contract.

The decision of a physician or 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.

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.