By: Angie Walters
As many dental clinics that treat Medicare patients are well aware, there is a deadline approaching to opt in or out of the Medicare system. By June 1, 2015, all dentists who wish to continue treating Medicare patients and to continue to prescribe medication to their qualifying patients with Part D drug plans must either decide to opt into the system as a provider, or opt out of the system completely. While there are benefits to both positions, dentists who do not make their formal decision by the deadline will face problems when making referrals or prescribing treatments or medications to their Medicare patients.
The Opt In/Out Timeline
Last year, the Centers for Medicare and Medicaid Services (CMS) created a rule that all physicians who wish to treat patients on Medicare, with reimbursement from the program, must enroll as a provider by June 1, 2015. This is a complicated process that requires enrollment in the program, with proof that the clinic meets Medicare standards. Those who wish to opt out must file an affidavit with all applicable Medicare carriers in the area. There is also a third option for providers to apply as a Medicare ordering and referring provider.
Why Opt In or Out?
The decision to enroll as a provider, as an ordering and referring provider, or to opt out entirely depends on the individual clinic. Medicare provides minimal dental coverage, only as the treatments relate to other covered medical conditions. When dentists choose to enroll as providers, they must meet specific standards for diagnostic approaches and billing. This allows the clinic to receive reimbursement for treatment directly from Medicare. Clinics that choose to opt out will not receive reimbursement from the program. However, clinics that opt out will still be able to write prescriptions for patients to be reimbursed by Medicare, under the program’s Part D prescription drug coverage.
Enrolling as a Provider
CMS provides a website with forms available for download for anyone wishing to enroll as a Medicare provider. The system is available completely online, with the ability to submit accompanying documents online as well. Clinics must agree to accept set payments for Medicare reimbursement. They must also demonstrate that they understand what services are covered or not covered, and that they will adhere to proper billing procedures.
The American Dental Association (ADA) notes that opting out of Medicare coverage does not mean that a provider’s patients will not receive coverage for prescription medications prescribed by the dentist. It only indicates that the few dental services typically covered by Medicare will not be reimbursed by the program. Once a dentist has opted out of Medicare, the provider may not submit a new application to opt in or out for two years.
Medicare Ordering and Referring Providers
Some dental clinics do not wish to enroll as Medicare providers, but they still interact with Medicare patients on a regular basis. These clinics may choose to enroll as Medicare Ordering and Referring Providers. In this program, providers do not directly receive reimbursement from Medicare for services provided. However, with online enrollment, the provider is added to the Medicare Ordering and Referring Registry, as a clinic that may order testing or refer patients to clinics and specialists that are approved Medicare providers.
Ultimately, the decision to opt in or out of the Medicare system is one that should be made with care and consideration, and in a timely fashion. Those who do not opt in or out by the June 1st deadline will find that Medicare will stop providing coverage for services and prescriptions by December 1, 2015. The onus is on clinics to decide and put a plan into action.
Note: This content is accurate as of the date published above and is subject to change. Please seek professional advice before acting on any matter contained in this article.