2006 proposed fee schedule - American Society of Clinical Oncology

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and information about how pharmacy costs and reimbursement
for supplying oral drugs under Medicare compares to that of
other payers.
I. Private Contracts and Opt-Out Provision
[If you choose to comment on issues in this section, please
include the caption “PRIVATE CONTRACTS AND OPT-OUT” at the
beginning of your comments.]
Section 4507 of the BBA of 1997 amended section 1802 of
the Act to permit certain physicians and practitioners to
opt-out of Medicare if certain conditions were met, and to
provide through private contracts services that would
otherwise be covered by Medicare. Under these private
contracts, the mandatory claims submission and limiting
charge rules of section 1848(g) of the Act would not apply.
The amendments to section 1802 of the Act, which were
effective on January 1, 1998, made the provisions of the
Medicare statute that would ordinarily preclude physicians
and practitioners from contracting privately with Medicare
beneficiaries to pay without regard to Medicare limits
inapplicable if the conditions necessary for an effective
“opt-out” are met.
When a physician or practitioner fails to maintain the
conditions necessary for opt-out and does not take good
faith efforts to correct his or her failure to maintain
opt-out, current regulations at §405.435(b) specify the