Common Contracts
1 similar Private Contract contracts
PRIVATE CONTRACT – PROVIDER OPT-OUT OF MEDICAREPrivate Contract • September 5th, 2024
This agreement is between Dr. Matthew Russo (“Physician”) and patient (“Patient”). The Patient is a Medicare Part B beneficiary seeking Services covered under Medicare Part B pursuant to Section 4507 of the Balanced Budget Act of 1997. Physician has informed Patient that Physician has opted out of the Medicare program effective on January 1, 2025 for a period of at least two years until January 1, 2027. The above noted Physician is not and has not been excluded from participating in Medicare Part B under Sections 1128, 1156, 1892 or any other section of the Social Security Act.
