[Code of Federal Regulations]

[Title 42, Volume 2]

[Revised as of October 1, 2005]

From the U.S. Government Printing Office via GPO Access

[CITE: 42CFR405.445]



[Page 105-106]

 

                         TITLE 42--PUBLIC HEALTH

 

                    CHAPTER IV--CENTERS FOR MEDICARE

                          & MEDICAID SERVICES,

                        DEPARTMENT OF HEALTH AND

                             HUMAN SERVICES

 

PART 405_FEDERAL HEALTH INSURANCE FOR THE AGED AND DISABLED--Table of 

Contents

 

                       Subpart D_Private Contracts

 

Sec. 405.445  Renewal and early termination of opt-out.



    (a) A physician or practitioner may renew opt-out by filing an 

affidavit with each carrier with which he or she would file claims 

absent completion of opt-out, provided the affidavits are filed within 

30 days after the current opt-out period expires.

    (b) To properly terminate opt-out a physician or practitioner must:

    (1) Not have previously opted out of Medicare.



[[Page 106]]



    (2) Notify all Medicare carriers, with which he or she filed an 

affidavit, of the termination of the opt-out no later than 90 days after 

the effective date of the opt-out period.

    (3) Refund to each beneficiary with whom he or she has privately 

contracted all payment collected in excess of:

    (i) The Medicare limiting charge (in the case of physicians); or

    (ii) The deductible and coinsurance (in the case of practitioners).

    (4) Notify all beneficiaries with whom the physician or practitioner 

entered into private contracts of the physician's or practitioner's 

decision to terminate opt-out and of the beneficiaries' right to have 

claims filed on their behalf with Medicare for the services furnished 

during the period between the effective date of the opt-out and the 

effective date of the termination of the opt-out period.

    (c) When the physician or practitioner properly terminates opt-out 

in accordance with paragraph (b), he or she will be reinstated in 

Medicare as if there had been no opt-out, and the provision of Sec. 

405.425 shall not apply unless the physician or practitioner 

subsequently properly opts out.

    (d) A physician or practitioner who has completed opt-out on or 

before January 1, 1999 may terminate opt-out during the 90 days 

following January 1, 1999 if he or she notifies all carriers to whom he 

or she would otherwise submit claims of the intent to terminate opt-out 

and complies with paragraphs (b)(3) and (4) of this section. Paragraph 

(c) of this section applies in these cases.