Common Contracts
1 similar Medicare Opt Out Agreement contracts
Medicare Opt Out Agreement for MD, NP (Hall & Lambour)Medicare Opt Out Agreement • April 11th, 2021
20176 and the patient: __ _ ("Patient"). 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. The Provider has informed Patient that the provider has opted out of the Medicare program effective from 12/ 02/2017 to 12/02/2019, and is not excluded from participating in Medicare Part B under Sections 1128, 1156, or 1892 or any other section of the Social Security Act.
