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 statute, the physician or practitioner cannot choose to opt out of Medicare for some Medicare beneficiaries, but not others. If the decision is made to opt out, then private contracts will need to be provided for all Medicare beneficiaries the physician or practitioner renders services.

Please complete and submit the NGS Medicare Private Contract form. This will ensure that you are meeting all the requirements of the private contract.

Related Content

• Centers for Medicare & Medicaid Services (CMS) Internet-Only Manual (IOM) Publication 100-02, Medicare Benefit Policy Manual, Chapter 15, Section 40

Reviewed 6/18/2024