Private Contracting with Medicare Beneficiaries
Background/Summary
The provision regarding private contracting with Medicare
beneficiaries became effective for contracts entered on or
after January 1, 1998. The regulatory language and specific
requirements for private contracting are part of a final Medicare
rule published November 2 in the Federal Register.
Effective January 1, 1998, BBA 97 permits certain physicians
and practitioners (nurse practitioners, physician assistants,
other non-physician providers) to contract privately with
Medicare beneficiaries if the physicians and practitioners
file an affidavit with the Medicare carrier opting-out of
Medicare for two years. The private contracting rules only
apply when a physician or practitioner furnishes Part B Medicare-covered
services to a beneficiary who is enrolled in Medicare Part
B.
This rule provides regulations to the operating policies
HCFA has already issued to Medicare carriers to implement
the private contracting provision. The rule also provides
ancillary policies that HCFA believes are necessary to clarify
definitions of terms such as emergency and urgent care services,
legal representative and beneficiary; the required elements
that must appear in the contract between the provider and
the beneficiary; the required elements that must appear in
the affidavit that the provider must file with Medicare to
opt-out; procedures for resolving potential disputes, contract
termination, payment terms, and many other conditions. All
specifications and requirements for private contracts are
contained in this rule.
Administration Action
Final regulations were published November 2, 1998 (63
Federal Register, text and PDF, 58814-59190).
Contacts
Denise Dodero, Associate Vice President
AAMC Health Care Affairs
ddodero@aamc.org
(202) 828-0493
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