A provider's opt-out status may be voluntarily terminated within a 90-day window of the opt-out effective date (as established by the affidavit) if this is the provider's first opt-out period. This early termination option applies only to initial opt-out providers and does not apply to providers whose opt-out status is renewing. When the opt-out is terminated, any prior Medicare enrollments are reactivated as of the termination date. After the 90-day window ends, the provider generally remains opted out until the end of the two-year cycle unless a timely cancellation request is submitted. Providers should submit a signed (in ink) and dated termination request via mail when seeking to terminate opt-out status within the 90-day window.

Reconsideration Requests for Opt-Out Decisions

If you disagree with a Medicare decision related to your opt-out status, you have the right to request a reconsideration (a review of that decision). Medicare Administrative Contractors (MACs) will review these requests when they are submitted on time and signed appropriately.

You may request a reconsideration for the following opt-out situations:

• Automatic renewal of your opt-out status
• Missing the deadline to cancel your opt-out renewal
• Requesting to end your opt-out early
• Termination of your opt-out status
• The effective date of your opt-out status

When your request is reviewed, Noridian will confirm that any required notices were sent to your most current address on file and within CMS-required timeframes. This is especially important for cases involving automatic renewal of your opt-out period. Your reconsideration request must be submitted within the required timeframe, include a proper signature, and meet all other standard reconsideration requirements.

Once your request is received, Noridian will acknowledge receipt of your request, review any additional information, and issue a decision. The decision letter you receive will include information about your next steps if you disagree with the outcome. This includes your right to further appeal. If your request involves a situation not clearly covered under current guidance, Noridian may seek additional direction from CMS before taking any action on your request.

Reconsideration Request Examples

Example One: Untimely Cancellation of Auto-Renewal

Dr. Red is a licensed psychiatrist who initially opted-out of Medicare effective January 1, 2020. His opt-out status automatically renewed on January 1, 2022, and January 1, 2024. On February 10, 2024, the MAC receives a reconsideration request from Dr. Red stating that he wishes to cancel his opt-out and enroll in the Medicare program as a supplier. The MAC accepts this reconsideration request as both a termination request and a cancellation request. The MAC confirms that the auto-renewal notices were sent to Dr. Red at his address of record at least 90 days before his opt-out status renewed. Because Dr. Red's request was received more than 90 days after his initial effective date, the MAC determines that he has failed to properly and timely terminate his opt-out status. In addition, because it is more than 90 days before his opt-out status will automatically renew (i.e. 90 days before January 1, 2026), the MAC also determines that Dr. Red has failed to properly and timely cancel the automatic renewal of his opt-out.

Example Two: Untimely Termination Request

Dr. Orange is a licensed neurologist who has never previously enrolled in Medicare nor opted-out of Medicare. They submitted an opt-out affidavit to the MAC which was signed on June 1, 2024. In a letter dated July 1, 2024, the MAC approves Dr. Orange's affidavit, effective June 1, 2024. The initial approval letters states that Dr. Orange has until August 30, 2024 to terminate their opt-out. On September 2, 2024, the MAC receives Dr. Orange's termination request. On September 3, 2024, the MAC returns the termination request as untimely. Dr. Orange responds on September 4, 2024 requesting reconsideration. The MAC accepts the reconsideration request and confirms that the approval letter was sent to Dr. Orange's address of record. Because Dr. Orange's termination request was received more than 90 days after the effective date of their opt-out status, the MAC determines that they failed to properly terminate their opt-out status. In addition, because it is more than 90 days before their opt-out status will automatically renew (i.e. 90 days before June 1, 2026), the MAC also determines that Dr. Orange has failed to properly and timely cancel the automatic renewal of their opt-out status.

Example Three: Opt-out Effective Date Appeal

Dr. Yellow was enrolled in Medicare as an individual physician. With her initial CMS-855I enrollment application, Dr. Yellow included a form CMS-460, and was enrolled as a participating physician. She submitted an opt-out affidavit to the MAC which was signed on August 12, 2024. In a letter dated September 2, 2024, the MAC approved Dr. Yellow's affidavit, effective August 12, 2024. On September 9, 2024, the MAC receives Dr. Yellow's reconsideration request to challenge the effective date of her opt-out approval. Dr. Yellow argues that her opt-out approval status should be October 1, 2024 because she was previously enrolled as a participating physician. The MAC finds that Dr. Yellow submitted the opt-out affidavit more than 30 days before the start of the next calendar quarter (October 1, 2024). Therefore, the MAC issues a favorable reconsideration decision and changes Dr. Yellow's opt-out status effective date to October 1, 2024.