Providers must submit affidavits to CMS to opt out of Medicare, meaning neither the provider nor the providers' patients can bill Medicare for provided health care services. CMS updates the data quarterly based on information in the Provider Enrollment, Chain, and Ownership System. The agency estimates more than 1.3 million providers currently bill Medicare.
Fewer providers opt out of Medicare
The latest data show the number of providers who filed affidavits to opt out of Medicare decreased from about 7,400 in 2016 to about 3,700 in 2017. According to Modern Healthcare, the number of providers who filed such affidavits hovered around 100 in 2010 and 2011, but filings began to rise in 2012, with steep increases in 2015 and 2016. Below is bar graph with data on the number of providers who filed opt out affidavits from 2010 through 2017:
CMS did not provide an explanation for the decline in the number of providers filing affidavits to opt out of Medicare.
However, some industry experts suggested the initial rise in opt-out affidavits likely was tied to low provider reimbursement rates and increasing regulations. For instance, Donna Kinney, director of research and data analysis at the Texas Medical Association, said, "Between price controls and the administrative burden, there is real concern about Medicare."
Others pointed to MACRA to explain last year's decline. Previously, providers had to renew their opt-out affidavits every two years, but under MACRA those opt-outs remain in place until a provider asks to rejoin the Medicare program, according to Modern Healthcare.
Anders Gilberg, SVP of government affairs for the Medical Group Management Association, said, "Figures from 2015 and 2016 may represent the first wave of physicians opting out and lower 2017 data may reflect the fact that physicians no longer need to file affidavits to renew."
Jaan Sidorov, CEO of the Care Centered Collaborative, said the United States' aging population might help to explain the decline. "As the percentage of Medicare patients goes up it makes it harder to walk away from that program," Sidorov said.
Jane Orient, an internist and executive director of the Association of American Physicians and Surgeons, said the number of opt-out affidavits might have declined because fewer physicians are in private practice and their contracts might have restrictions on opting out of Medicare (Dickson, Modern Healthcare, 1/30; CMS data, accessed 1/31).
Medicare 101: Cheat sheets for Parts A through D
Through the years Medicare has grown more complicated, including private supplemental insurance and prescription drug coverage. Download our cheat sheets to learn how each of the four parts of Medicare works, and why they’re so important for provider organizations: