Denial of Payment to Employers of Opt-Out Physicians and Practitioners

40.30 - Denial of Payment to Employers of Opt-Out Physicians and Practitioners (Rev. 160, Issued: 10-26-12, Effective: 01-28-13, Implementation: 01-28-13) If an opt-out physician or practitioner is employed in a hospital setting and submits bills for which payment is prohibited, the Medicare contractor usually detects and investigates the situation. However, in some instances an opt-out physician or practitioner may have a salary arrangement with a hospital or clinic or work in a group practice and may not directly submit bills for payment. If the Medicare contractor detects this situation, it must recover the payment made for the opt-out physician/practitioner from the hospital/clinic/group practice, after appropriate notification.