Thursday, February 26, 2015

What All Dentists Need To Know About Medicare Enrollment

Does your practice service patients 65&over who have medicare coverage? 

Here are some important details that our friends at Veros Dental recently shared about the 2015 Medicare Enrollment

 Any dentist, including a specialist, who treats Medicare beneficiaries must either enroll in the Medicare program or opt out in order to prescribe medication to their qualifying patients with Part D drug plans. Most every patient 65 years of age and older is a Medicare beneficiary. 

This decision should be made promptly and the process should be undertaken now to ensure implementation by the June 1, 2015 deadline.

Only those dentists who do not treat Medicare eligible beneficiaries (65 years or older patients and certain disabled individuals) are free from making a decision and acting. By not acting (creating a formal status with Medicare), Medicare eligible patients will not be covered for prescriptions you write for them (this will tend to irritate them as their coverage should cover most all prescriptions and will not be covered solely because of your failure to act).

If you treat Medicare beneficiaries and must make a decision, there are actually two decisions you have to make. The first is whether to enroll or opt out. The second, if you enroll, is whether to enroll as a Medicare provider or enroll as an ordering/referring provider.

ENROLL - Medicare Provider

By enrolling as a Medicare provider, you are agreeing to accept the Medicare fee schedule for covered procedures you perform for these patients. Dentists perform few of these services but may include biopsies, some TMJ services and sleep apnea. If you do enroll, you'll have to follow Medicare procedures for claim submission. This enrollment then also allows your Medicare patient prescription to be covered.

ENROLL - Ordering/Referring Provider

If you do not perform any Medicare covered services, you may choose to enroll as an ordering/referring provider. This allows service providers to whom you refer Medicare patients to get paid (labs, imaging services, other procedures). It also allows your Medicare beneficiary patients to have their prescriptions covered. You will not be able to perform Medicare-covered services under this status, however. 


At first take, choosing to opt out sounds like it would be the easy approach. It isn't that simple. By choosing to opt out, your practice will actually be required to send an affidavit to the Medicare carrier in your region. The opt out affidavit lasts for two years. At the end of the two-year period, you are faced with the same decision again -- to enroll or opt out.
In addition to the document you must file with Medicare, you also need to inform your Medicare beneficiary patients and have each of them enter into a written private contract. This contract is an agreement that you are not an enrolled Medicare provider and that the patient won't submit any covered treatment claims to Medicare. These contracts will need to be kept as records of the practice and also need to be renewed every two years. This contract must follow all of the specific Medicare stipulations (even including the appropriate font size!) for it to be valid.
By having these contracts in place, the practice can follow their own fee schedule for the Medicare covered procedures, and the patients can have their Part D prescriptions covered under Medicare.

How to Decide?

Each practice will need to formulate their best approach to what to do. Here are some considerations:
  • Do you or will you see a Medicare eligible patient in the next two years? If yes, you have to make a decision. If not, there is nothing for you to do from here.
  • How many Medicare eligible patients will you see? Run a demographic report to learn how many active patients you have over the age of 65. If this is low, consider opting out. Opting out actually will result in more work, as every patient over 65 will need to sign an agreement with you every two years. So depending on the numbers, opting out could possibly cost a lot of time.
  • Do you perform Medicare procedures? If you do, you'll need to consider whether you want to accept their fee schedule (enroll) or not (opt out). If you do perform these procedures, a thorough analysis of your fees and the Medicare fee schedule should be considered.
  • If you do not perform the Medicare procedures but don't want the ongoing burden of the opt-out paperwork, then enrolling as an ordering/referring provider is likely the best option. You won't be able to send claims to Medicare, but your referred service providers will get paid and your patients' prescriptions will be covered. You can enroll later as a Medicare provider, if necessary.
If your your patients are affected, be sure to make the implementation by the June 1, 2015 deadline

For additional information and/or questions specific to your practice,contact one of our Dental CPA team members at 800-772-1065 or Don't delay your decision, give us a call and we can help guide you to the best solution that works for your practice. 

Also visit the ADA website as well as DentistryIQ for additional articles related to the medicare enrollment

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