GJ - JE Part B
"Opt out" physician or practitioner emergency or urgent services
In an emergency or urgent care situation, a physician/practitioner who opts out may treat a Medicare beneficiary with whom he/she does not have a private contract and bill for such treatment. In such a situation, the provider may not charge the beneficiary more than what a nonparticipating physician/practitioner would be permitted to charge and must submit a claim to Medicare on the beneficiary's behalf.
- Example - Physician was called in to see a patient in the emergency room whom he has not seen before and no contract was signed
Claim Coding Example
- Opt out physician to append for non-emergent services that have a private contract with patients.
Last Updated Thu, 13 Feb 2020 12:48:03 +0000