CMS Pub. 100-02, ch. 15, § 40.10

A. A physician/practitioner fails to properly opt-out for any of the following reasons:

• Any private contract between the physician/practitioner and a Medicare beneficiary that was entered

into before the affidavit described in §40.9 was filed does not meet the specifications of §40.8; or

• The physician/practitioner fails to submit the affidavit(s) in accordance with §40.9.

B. If a physician/practitioner fails to properly opt-out in accordance with the above paragraphs of

this section, the following will result:

• The physician’s or practitioner’s attempt to opt-out of Medicare is nullified, and all of the private

contracts between the physician/practitioner and Medicare beneficiaries for the 2 year period

covered by the attempted opt-out are deemed null and void;

• The physician/practitioner must submit claims to Medicare for all Medicare-covered items and

services furnished to Medicare beneficiaries, including the items and services furnished under the

nullified contracts. A nonparticipating physician/practitioner is subject to the limiting charge

provision. For items or services paid under the physician fee schedule, the limiting charge is 115

percent of the approved amount for nonparticipating physicians or practitioners. A participating

physician/practitioner is subject to the limitations on charges of the participation agreement the

physician/practitioner signed;

• The physician/practitioner may not reassign any claim except as provided in the Medicare Claims

Processing Manual, Chapter 1, “General Billing Requirements,” §§30.2.12 and 30.2.13;

• The physician/practitioner may neither bill nor collect an amount from the beneficiary except for

applicable deductible and coinsurance amounts; and

• The physician/practitioner may make another attempt to properly opt-out at any time.