Opt-Out Physician or Practitioner Providing Emergency or Urgent Care

Opt-Out Physician or Practitioner Providing Emergency or Urgent Care In an emergency or urgent situation, a physician or practitioner who opts out may treat a Medicare beneficiary with whom they do not have a private contract. In this [...]

Providers Not Eligible to Opt Out and Enter Into Private Contracts

Providers Not Eligible to Opt Out and Enter Into Private Contracts Providers Who May Not Opt Out of the Medicare Program Chiropractors Opt-out law does not define ‘physician’ to include chiropractors; therefore, they may not opt out of [...]

Instructions to File

Instructions to File The requirements to opting out of Medicare are included on the forms. First, at least one private contracting agreement form must be signed between the physician or practitioner and a beneficiary. Second, the physician [...]

Requirements of Medicare Private Contracting Agreement

Requirements of Medicare Private Contracting Agreement Amendment 4507 of the Balanced Budget Act of 1997 permits a physician or practitioner to “opt out” of Medicare and enter into private contracts with Medicare beneficiaries. Under the [...]

Approval or Denial

Approval or Denial Once your affidavit is approved, you will receive an approval letter of opt-out status along with the opt-out effective date. Review this letter to ensure that everything is accurate and if you have any questions, please [...]

Requests for Additional information

Requests for Additional information While processing the affidavit, National Government Services may determine additional information is needed. All requested information should be submitted as soon as possible, but no later than 30 days from [...]

Organizations That Furnish Physician or Practitioner Services

Organizations That Furnish Physician or Practitioner Services Opt-out regulations apply to all items or services the physician or practitioner furnishes to Medicare beneficiaries, regardless of the location where such services are furnished. [...]

Early Termination for First Time Opt-Out Providers

Early Termination for First Time Opt-Out Providers Opt-out affidavits are effective for two years and cannot be terminated early unless during the first time opt-out period and within 90 days of the effective date of the affidavit. A request [...]

Targeted Probe and Educate Educational Videos

Targeted Probe and Educate Educational Videos   Video Description Targeted Probe and Educate Learn more about the TPE Program.   Additional educational information can be found on our Events page and [...]

Medical Review: Targeted Probe and Educate Review Topics

Medical Review: Targeted Probe and Educate Review Topics Prevent technical denials by ensuring your medical records are legible and include a valid, legible provider signature. If you notice the provider signature is illegible when asked to [...]

Targeted Probe and Educate Review Topics

Targeted Probe and Educate Review Topics Prevent technical denials by ensuring your medical records are legible and include a valid, legible provider signature. If you notice the provider signature is illegible when asked to supply medical [...]

Targeted Probe and Educate Review Topics

Targeted Probe and Educate Review Topics Prevent technical denials by ensuring your medical records are legible and include a valid, legible provider signature. If you notice the provider signature is illegible when asked to supply medical [...]

Targeted Probe and Educate Review Topics

Targeted Probe and Educate Review Topics Prevent technical denials by ensuring your medical records are legible and include a valid, legible provider signature. If you notice the provider signature is illegible when asked to supply medical [...]

Medical Necessity of Vitamin D Assay Testing: Top Denials and How to Prevent Them

Medical Necessity of Vitamin D Assay Testing: Top Denials and How to Prevent Them Learn how to prevent common denials for Vitamin D Assay Testing (CPT Code 82306): 1. Testing may not be used for routine or other screening. There must be [...]

2024 DMEPOS HCPCS Jurisdiction Listing

MLN Connects® Newsletter: June 20, 2024

MLN Connects Newsletter: June 20, 2024 News CMS Preparing to Close Program that Addressed Medicare Funding Issues Resulting from Change Healthcare Cyber-Attack Federal Study Examines Care Following Nonfatal Overdose Among Medicare [...]

Medicare Coverage Exclusion: Dental Services

Medicare Coverage Exclusion: Dental Services It is imperative that our providers are educated regarding the exclusion of dental services from the Medicare Program. Medicare generally does not cover dental services. Since the inception of [...]

Medicare Coverage Exclusion: Dental Services

Medicare Coverage Exclusion: Dental Services Table of Contents Medicare Coverage Exclusion: Dental Services Dental Services Excluded Under Medicare Part B Exceptions to Dental Service Exclusion Inpatient Services in Connection With [...]

Best Practices for a Successful Targeted Probe and Educate Review

Best Practices for a Successful Targeted Probe and Educate Review Table of Contents Getting Started With TPE Notification Letter During the Review Process Post-Probe/Review Results Letter Prepare for Post-Probe Education [Return to [...]