Question about Medicare opt out/non-par

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Over the weekend, we had a little FP get together in the Pasadena area where IMPs, pre-IMPs and non-IMPS just chatted at an informal gathering at my house. I think it's good for the specialty and primary care in general to know our local colleagues, plus it helps spread the IMP message. Anyways, one of the questions that came up was: What do you do if you have never enrolled as a provider with Medicare? Are you a non-participating doctor or are you considered opted out? Do you have to enroll with Medicare just so you can opt out? Since this question may be relevant to others on the listserve, I thought I would post what I found out here.From the American Psychiatric Association: http://pn.psychiatryonline.org/cgi/content/full/43/20/16Q. I have never enrolled as a Medicare provider and would like to opt out of the program. When I contacted my Medicare carrier, I was told I had to enroll before I opted out. Is this true?A. No. The Medicare carrier (or contractor) does need to be able to identify you, however, so you must provide your NPI, as well as your address, tax identification number, and medical license number. If you use the opt-out affidavit posted on APA's Web site, you will provide the carrier with all the necessary information. The affidavit can be accessed at the bottom of this Web page: <www.psych.org/MainMenu/PsychiatricPractice/MedicareMedicaid/OptingOutofMedicare.aspx>. -----------------------------This is from AAFP's web site:http://www.aafp.org/online/en/home/practicemgt/mcareoptions.htmlThere are basically three Medicare contractual options for physicians. Physicians may sign a participating (PAR) agreement and accept Medicare's allowed charge as payment in full for all of their Medicare patients. They may elect to be a non-PAR physician, which permits them to make assignment decisions on a case-by-case basis and to bill patients for more than the Medicare allowance for unassigned claims. Or they may become a private contracting physician, agreeing to bill patients directly and forego any payments from Medicare to their patients or themselves.Based on the above, my interpretation (which may not be correct) is that you have to choose one of these three options. If you have never enrolled in Medicare and you do not enroll as a partipating provider and you do not formally opt out of Medicare, then you are automatically choosing the 3rd option and you are a non-participating provider and subject to the rules associated with that status, including limits on how much you may charge a patient. SetoSouth Pasadena, CA