A lot of providers have been asking themselves lately; "How does Medicare Enrollment actually affect my practice?" "Do I enroll, should I opt out?" "What happens if I just do nothing?" The first thing to understand when making the big decision as to whether or not you should opt out or enroll as a Medicare provider are the different parts of Medicare and how they concern your dental office. Below your will find a list of the different parts of the Medicare program with brief descriptions from the STATDDS Medicare specialists.
Medicare Part A — Hospital Insurance: Part A covers inpatient hospital stays, care in a skilled nursing facility, hospice care, and some home health care. This does not relate to most dental practices unless it is a hospital-based practice.
Medicare Part B — Medical Insurance: Part B covers medically necessary doctors' services, outpatient care, and preventive services. Some dental services that are medically necessary are included in Medicare Part B. An example is a medically necessary tooth extraction on a patient before he or she undergoes chemotherapy. There are a few other medically necessary dental services that Medicare Part B covers, but this includes very few dental services.
Medicare Part C — Medicare Advantage Plans: A Medicare Advantage Plan is a Medicare health plan offered by a private company that contracts with Medicare to provide all your Part A and Part B benefits. Medicare Advantage Plans include HMOs, PPOs, and other specialized plans. Because these plans are offered by private companies, these plans may also offer dental, drug, and vision coverage not offered by traditional Medicare.
Medicare Part D — Prescription Drug Coverage: Part D adds prescription drug coverage to the original Medicare. These plans are offered by insurance companies and other private companies approved by Medicare. Medicare Advantage Plans may also offer prescription drug coverage that follows the same rules as Medicare Prescription Drug Plans. This is the part of Medicare that is affected by your decision to opt in for billing, opt in for prescribing, or opt out of Medicare Part B.
Medicare DME — Durable Medical Equipment: Medicare pays dentists for oral appliances for obstructive sleep apnea. There are very specific criteria, and once a dentist is trained in this area and protocol, Medicare pays these claims in 30 days. Dentists should implement a dental sleep medicine program that is tied to bruxism therapy into their practices so that they can be primary providers with patients' physicians.
Next we need to evaluate how each decision affects your practice. A lot of providers have been choosing to either opt out or do nothing at all because they assume that opting out or doing nothing means that they will not have anything to do with Medicare. One thing you should keep in mind is that choosing to opt out of the Medicare program is not the same as doing nothing. If you choose to do nothing, patients enrolled in a Medicare Part D plan will not have coverage for any prescriptions that you write for them, nor will they have any coverage for any referrals that you make for them.
Opting out also does not mean that your practice will not have anything to do with Medicare. Simply put, opting out means that neither your or the patient are allowed to bill either Medicare or their Medicare Advantage plans for services for a period of two years. Arguably opting out actually requires the most paperwork. When you opt out, you must enter into a private agreement with any Medicare beneficiary that you treat. A private contract is a signed agreement signed by both you and your patient after you opt out and before providing any potentially covered services. The agreement has to notify the patient of your opt out status and also ensure that they are aware that services being performed will not be billed to Medicare for reimbursement.
In addition your opt out status will remain effective for a period of two years, and if you would like to maintain your opt out status you will be required to formally opt out every two years. Also if you were to choose to opt out, there is only a 90 day window in which you are able to change your opt out status. After 90 days your opt out designation will remain in an opt out status for a two year period. It should also be noted that some networks may make the decision to not allow providers to participate in any of their networks if they choose to opt out. This is already the case with Delta Dental in Ohio, Michigan, and Indiana. (See Article)
If you would like to bill Medicare for services covered under part B, opting in may be the best choice for your office. There aren't many dental services covered under Medicare part B so this may only be a good choice for your office if you perform a lot of oral surgery or treat oncology patients. For most general dental offices, it is often recommended to enroll as an ordering and referring provider under Medicare Part D. As an ordering and referring provider, you will be placed on the Medicare Ordering and Referring Registry and will be able to prescribe medications, as well as order and refer patients to Medicare-enrolled providers and suppliers.
Ultimately it is up to you to decide what's best for your practice but you should always be sure to make an informed decision when it comes to Medicare enrollment. For more information, please feel free to visit the links listed below.