Relationship Between Opt-Out and Medicare Participation Agreements

40.16 - Relationship Between Opt-Out and Medicare Participation Agreements (Rev. 160, Issued: 10-26-12, Effective: 01-28-13, Implementation: 01-28-13) Participation agreements will terminate on the opt out effective date. See 40.17 for effective date provisions. Physicians and practitioners may not provide services under private contracts with beneficiaries earlier than the effective date of the affidavit. Nonparticipating physicians and practitioners may opt out at any time. The Medicare contractor must update the system files so that it may timely pay participating physicians and practitioners at the correct payment amounts in effect for that part of the fee schedule year before they opt out and to pay them as nonparticipating for emergency or urgent care as of their opt out effective date.