Common Contracts
2 similar Medicare Private Contract contracts
SAMPLE MEDICARE PRIVATE CONTRACT IN COMPLIANCE WITH 42 U.S.C. §1395a; 42 C.F.R. § 405, SUBPART DMedicare Private Contract • July 27th, 2020
This contract is entered into by and between [insert name of physician] (hereinafter called “physician”), whose principal medical office is located at _____________________ and [insert name of Medicare beneficiary] (hereinafter called “beneficiary”), who resides at ______________________________, and shall become effective on this __ day of _____________, 20__ and shall expire on the __ day of _____________, 20__ (the “opt out period”), unless otherwise renewed in accordance with the 42 U.S.C. 1395a; 42 C.F.R. 405, Subpart D.
SAMPLE MEDICARE PRIVATE CONTRACTMedicare Private Contract • September 17th, 2008
This contract is entered into by and between [insert name of physician] (hereinafter called “physician”), whose principal medical office is located at and [insert name of Medicare beneficiary] (hereinafter called “beneficiary”), who resides at
