Application to the Medicare Advantage Program

40.37 - Application to the Medicare Advantage Program (Rev. 160, Issued: 10-26-12, Effective: 01-28-13, Implementation: 01-28-13) The Medicare Managed Care Manual contains instructions for Medicare Advantage plans about the impact on managed care. The manual provides in general that Medicare Advantage plans: • Must acquire and maintain information from Medicare contractors on physicians and practitioners who have opted out of Medicare. • Must make no payment directly or indirectly for Medicare covered services furnished to a Medicare beneficiary by a physician or practitioner who has opted out of Medicare, except for emergency or urgent care services furnished to a beneficiary who has not previously entered into a private contract with the physician or practitioner, in accordance with §40.28. The Medicare contractor must maintain mutually agreeable means of advising Medicare Advantage plans of who has opted out. Disputes with Medicare Advantage plans about the provision of opt out information should be referred to the regional office staff for resolution.