Skip to contents

Opt-Out Providers

Source: R/cms-opt_out.R
opt_out.Rd

Information on providers who have decided not to participate in Medicare.

Usage

opt_out(
  npi = NULL,
  first = NULL,
  last = NULL,
  specialty = NULL,
  address = NULL,
  city = NULL,
  state = NULL,
  zip = NULL,
  order_refer = NULL,
  count = FALSE,
  set = FALSE
)

Arguments

npi

<int> National Provider Identifier

first, last

<chr> Provider's name

specialty

<chr> Provider's specialty

address

<chr> Provider's address

city

<chr> Provider's city

state

<chr> Provider's state abbreviation

zip

<chr> Provider's zip code

order_refer

<lgl> Indicates order and refer eligibility

count

<lgl> Return the dataset's total row count

set

<lgl> Return the entire dataset

Value

A tibble

Opting Out

Providers who do not wish to enroll in the Medicare program may "opt-out", meaning neither they nor the beneficiary can bill Medicare for services rendered.

Instead, a private contract between provider and beneficiary is signed, neither party is reimbursed by Medicare and the beneficiary pays the provider out-of-pocket.

To opt out, a provider must:

  • Be of an eligible specialty type

  • Submit an opt-out affidavit to Medicare

  • Enter into a private contract with their Medicare patients

Opt-Out Periods

Opt-out periods last for two years and cannot be terminated early unless the provider is opting out for the very first time and terminates the opt-out no later than 90 days after the opt-out period's effective date. Opt-out statuses are effective for two years and automatically renew.

Providers may NOT opt-out if they intend to be a Medicare Advantage (Part C) provider or furnish services covered by traditional Medicare fee-for-service (Part B).

References

Examples

opt_out(count = TRUE)
#> ℹ opt_out has 55,330 rows.
opt_out(npi = 1043522824)
#> ✔ opt_out returned 1 result.
#> # A tibble: 1 × 12
#>          npi first last  specialty  start_date end_date   updated    city  state
#> *      <int> <chr> <chr> <chr>      <date>     <date>     <date>     <chr> <chr>
#> 1 1043522824 James Smith Nurse Pra… 2019-07-01 2027-07-01 2025-08-15 SCOT… AZ   
#> # ℹ 3 more variables: zip <chr>, order_refer <int>, address <chr>
opt_out(state = "AK")
#> ✔ opt_out returned 258 results.
#> # A tibble: 258 × 12
#>           npi first last  specialty start_date end_date   updated    city  state
#>  *      <int> <chr> <chr> <chr>     <date>     <date>     <date>     <chr> <chr>
#>  1 1265553432 Henry Chap… Physicia… 2012-04-01 2026-04-01 2024-05-15 ANCH… AK   
#>  2 1487879664 Ann   Stoc… Clinical… 2012-04-01 2026-04-01 2024-05-15 ANCH… AK   
#>  3 1043559362 Amber Shea  Nurse Pr… 2013-04-01 2027-04-01 2025-05-15 WASI… AK   
#>  4 1598825663 Robe… Skala Family P… 2013-06-04 2027-06-04 2025-07-15 EAGL… AK   
#>  5 1508198276 Robe… Cass… Dentist   2013-07-23 2027-07-23 2025-09-15 WASI… AK   
#>  6 1952340358 Eliz… Desc… Family P… 2014-04-01 2026-04-01 2024-05-15 ANCH… AK   
#>  7 1124176227 Evel… Wisz… Clinical… 2018-07-01 2026-07-01 2024-08-15 KODI… AK   
#>  8 1154467520 Suza… Stra… Nurse Pr… 2014-04-01 2026-04-01 2024-05-15 EAGL… AK   
#>  9 1295755296 Will… Berg… Oral Sur… 2018-11-05 2026-11-05 2024-12-15 ANCH… AK   
#> 10 1225058977 Ray   Holl… Oral Sur… 2014-06-16 2026-06-16 2024-07-15 ANCH… AK   
#> # ℹ 248 more rows
#> # ℹ 3 more variables: zip <chr>, order_refer <int>, address <chr>
opt_out(specialty = "Psychiatry", order_refer = FALSE)
#> ✔ opt_out returned 798 results.
#> # A tibble: 798 × 12
#>           npi first last  specialty start_date end_date   updated    city  state
#>  *      <int> <chr> <chr> <chr>     <date>     <date>     <date>     <chr> <chr>
#>  1 1720444581 Jona… Rain… Psychiat… 1998-01-30 2028-01-30 2026-02-16 GLAD… PA   
#>  2 1598802100 Mart… Leat… Psychiat… 2012-04-01 2026-04-01 2024-10-15 SAN … TX   
#>  3 1972623346 Nancy Shos… Psychiat… 2012-03-02 2026-03-02 2024-10-15 DALL… TX   
#>  4 1124116793 Namir Daml… Psychiat… 2020-07-26 2026-07-26 2024-08-15 ENCI… CA   
#>  5 1427146331 Lawr… Corm… Psychiat… 2012-05-10 2026-05-10 2024-10-15 DENV… CO   
#>  6 1114132313 Char… Scha… Psychiat… 2012-06-14 2026-06-14 2024-10-15 SACR… CA   
#>  7 1093894420 Andr… Popp… Psychiat… 2012-06-01 2026-06-01 2026-01-15 NEWT… MA   
#>  8 1871501395 Ingr… Schm… Psychiat… 2010-09-02 2026-09-02 2024-10-15 AUST… TX   
#>  9 1477614204 Lore… Henry Psychiat… 2012-05-26 2026-05-26 2024-10-15 COLL… TX   
#> 10 1932284098 Patr… Mcgr… Psychiat… 2012-06-01 2026-06-01 2024-07-15 NEW … NY   
#> # ℹ 788 more rows
#> # ℹ 3 more variables: zip <chr>, order_refer <int>, address <chr>