Common Contracts
1 similar Medicare Private Contract contracts
MEDICARE PRIVATE CONTRACTMedicare Private Contract • September 17th, 2012
The Physician acknowledges that he is excluded from Medicare under sections 1128, 1156, 1892 or any other section of the Social Security Act. The Physician acknowledges that this contract shall not be entered into with the Beneficiary, or the Beneficiary's legal representative, during a time when the Beneficiary requires emergency care services or urgent care services, except that the Physician may furnish emergency or urgent care services to a Medicare beneficiary in accordance with 42 C.F.R. § 405.440. The Physician acknowledges that he must retain this contract (with original signatures of both parties to this contract) for the duration of the opt-out period, and that it shall be made available to the Centers for Medicare and Medicaid Services (CMS) upon request. The Physician shall provide a copy of this contract to the Beneficiary, or to his or her legal representative, before items or services have been furnished to the Beneficiary under the terms of this contract. The Physician
