Cash Only Is Not the Same as Opted Out of Medicare

Rachael Lara

12 hours ago

2 min read

Make the Medicare decision deliberately

A marriage and family therapist may decide to operate a private-pay practice. For Medicare patients receiving otherwise covered services, however, a cash-only statement on the website does not establish a valid Medicare opt-out.

MFTs became eligible to bill Medicare independently for qualifying services effective January 1, 2024. CMS and its contractor guidance also recognize an opt-out pathway for eligible MFTs. Enrollment and opting out are different processes. [1, 2]

Use the required process

CMS describes opting out as requiring an affidavit and private contracts with Medicare patients. Its guidance warns that a practitioner cannot opt out selectively for certain Medicare patients or services while keeping ordinary Medicare billing for others. Emergency and urgent care involve additional rules. [2]

A generic financial consent or a statement that the practice does not accept insurance should not be treated as a substitute. Before seeing Medicare patients on a private-contract basis, confirm the required terms, filing process, and effective date with the Medicare Administrative Contractor.

The decision also needs to reach scheduling and billing. Staff should know what to tell a prospective patient, which paperwork applies, and why a superbill cannot be presented as a route to Medicare payment for privately contracted services.

Plan for changes in the practice

If an MFT joins a group, leaves a group, or changes business arrangements, review the individual's Medicare status before promising insurance billing. A new business name should not be assumed to cancel an existing opt-out.

CMS's MFT guidance describes a two-year opt-out period with automatic renewal unless the practitioner timely terminates it. Put the relevant dates on an administrative calendar instead of relying on memory. [3]

Private-pay care can be a considered practice choice. The problem is treating non-enrollment, out-of-network status, and formal Medicare opt-out as if they all mean the same thing. They do not.