General Rules of Private Contracts

40.2 - General Rules of Private Contracts (Rev. 222, Issued: 05-13-16, Effective: 08-15-16, Implementation; 08-15-16) The following rules apply to physicians/practitioners who opt-out of Medicare: • A physician/practitioner may enter into one or more private contracts with Medicare beneficiaries for the purpose of furnishing items or services that would otherwise be covered by Medicare (provided the conditions in §40.1 are met). • A physician/practitioner who enters into at least one private contract with a Medicare beneficiary (under the conditions of §40.1) and who submits one or more affidavits in accordance with §40.9, opts-out of Medicare unless the opt-out is terminated early according to §40.35 or unless the physician/practitioner fails to maintain opt-out. (See §40.11.) • Valid opt-out affidavits signed on or after June 16, 2015, will automatically renew every 2 years. If physicians and practitioners who file affidavits effective on or after June 16, 2015, do not want their opt-out to automatically renew at the end of a 2 year opt-out period, they may cancel the renewal by notifying all contractors with which they filed an affidavit in writing at least 30 days prior to the start of the next opt-out period. Valid opt-out affidavits signed before June 16, 2015, will expire 2 years after the effective date of the opt-out. If physicians and practitioners that filed affidavits effective before June 16, 2015, want to extend their opt-out, they must submit a renewal affidavit within 30 days after the current opt-out period expires to all contractors with which they would have filed claims absent the opt-out. • Both the private contracts described in the first paragraph of this section and the physician’s or practitioner’s opt-out described in the second paragraph of this section are null and void if the physician/practitioner fails to properly opt-out in accordance with the conditions of these instructions. • Both the private contracts described in the first paragraph of this section and the physician’s or practitioner’s opt-out described in the second paragraph of this section are null and void for the remainder of the opt-out period if the physician/practitioner fails to remain in compliance with the conditions of these instructions during the opt-out period. • Services furnished under private contracts meeting the requirements of these instructions are not covered services under Medicare, and no Medicare payment will be made for such services either directly or indirectly.