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CMS Reports Fewer Doctors Opt Out of Medicare Participation in 2017

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The Centers for Medicare & Medicaid Services (CMS) is reporting a sharp decrease in the number of doctors and other medical clinicians opting out of Medicare participation in 2017.

At this point, it is unknown why the numbers went down last year. It may be because under the Medicare Access and CHIP Reauthorization Act (MACRA), providers no longer have to submit an Opt Out Affidavit every 2 years. Instead, once doctors have opted out of Medicare participation, they stay out indefinitely until they decide to rejoin the program.

Altogether, 3,732 providers dropped out in 2017. This is almost a 50% reduction compared to the prior year when 7,400 dropped out in 2016, but is on par with the 2015 rate of 3,500.

Opting Out of Medicare

The “Opt Out” process is a contract between a provider and Medicare, as well as separate contracts between a provider and beneficiaries. The contracts specify that the provider or beneficiary does not file a claim to Medicare for services rendered. In this case, the health care provider bills the beneficiary directly. Neither party is reimbursed by Medicare.

The provider does not have to follow the fee-for-service charges established by Medicare.

A private contract is signed between the health care provider and the beneficiary, stating that neither one can receive payment from Medicare for services. More information is available at this MLN Matters publication.

The Opt Out process requires that providers submit an affidavit to that effect with Medicare.

In essence, the 2017 change specifies that the former Opt Out 2-year periods are automatically renewed without any action required by the provider.

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