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Opt-Out Providers

Source: R/end-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,
  start_year = NULL,
  address = NULL,
  city = NULL,
  state = NULL,
  zip = NULL,
  order_refer = NULL,
  count = FALSE
)

Arguments

npi

<int> National Provider Identifier

first, last

<chr> Provider's name

specialty

<chr> Provider's specialty

start_year

<int> Opt-out effective date year

address, city, state, zip

<chr> Provider's address, city, state, zip

order_refer

<lgl> Indicates order and refer eligibility

count

<lgl> Return the total row count

Value

A tibble containing the search results.

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)
#> ◼ opt_out | 56,300 rows | 12 pages

opt_out(state = "GA", specialty = contains("Psych"))
#> ✔ opt_out returned 226 results
#> ✔ Retrieving 1 page
#> ✔ order_refer returned 128 results
#> ✔ Retrieving 1 page
#> # A tibble: 226 × 12
#>         npi first last  specialty start_date end_date   updated    address city 
#>  *    <int> <chr> <chr> <chr>     <date>     <date>     <date>     <chr>   <chr>
#>  1   1.88e9 Ana   Adel… Clinical… 2012-07-01 2026-07-01 2024-08-15 675 SE… ATLA…
#>  2   1.98e9 Joan  Mill… Clinical… 2014-07-01 2026-07-01 2024-08-15 2520 W… MARI…
#>  3   1.68e9 Sher… Born… Clinical… 2012-04-01 2028-04-01 2026-04-16 990 HA… ATLA…
#>  4   1.70e9 Nich… Hume  Clinical… 2018-07-01 2026-07-01 2024-08-15 693 MO… ATLA…
#>  5   1.60e9 Carol Kran… Psychiat… 2012-01-01 2028-01-01 2026-01-15 3133 M… ATLA…
#>  6   1.12e9 Lawr… Gius… Psychiat… 2012-07-01 2026-07-01 2024-08-15 1945 C… ATLA…
#>  7   1.84e9 David Lips… Psychiat… 2012-07-01 2026-07-01 2024-08-15 12 PIE… ATLA…
#>  8   1.88e9 Barb… Da V… Psychiat… 2012-07-01 2026-07-01 2024-08-15 143 FO… ST S…
#>  9   1.29e9 Matt… Norm… Psychiat… 2012-10-01 2026-10-01 2024-11-15 3495 P… ATLA…
#> 10   1.30e9 Linda Ande… Clinical… 2013-01-01 2027-01-01 2025-01-15 4675 N… ATLA…
#> # ℹ 216 more rows
#> # ℹ 3 more variables: state <chr>, zip <chr>, order_refer <chr>