MEDICARE
Part B or not to Part B
Why is this even a question?
tell you “NO!” Let me say it again, “NO!”
NEWS FLASH! I'm sorry but a decision must
be made and the sooner you take action, the
better. Dentists’ ability to write prescriptions and
refer covered services for Medicare
patients will be affected. With over 50 million
Medicare patients, this decision will affect the
majority of dental practitioners across the U.S.
While routine dental treatment is not a covered
benefit under any Medicare plan, there are
exceptions when dental treatment is directly
linked to a covered medical treatment. The
options you have as a dental provider are as
follows:
Lesia Crawford,
CEO, GoGo Billing
877-874-4646 ext. 1
[email protected]
This month’s article was slated to be about
supplemental Medicare plans vs secondary
plans. However, I’ve decided to postpone that
riveting article to bring an extremely
time-sensitive matter to the table. After
speaking with many of our new and existing
clients, it has become abundantly clear that most
dental offices are NOT aware of the June 1st
deadline requiring them to enroll or opt out of
Medicare Part B.
You may be unfamiliar with coverage the
different parts of the Medicare system provide.
Here is a simple outline:
Part A- Hospital Insurance
Part B- Medical Insurance
Part C- Medicare Advantage Plans, a
private replacement plan for part B
Part D- Prescription drug coverage
Medicare DME- Durable Medical Equipment (sleep apnea devices)
So you may be confounded, wondering, “How
this will affect me?” or worse, “I’m a dentist.
Can’t I just ignore this situation?” I am here to
Medicare Part B participating or
non-participating provider. You can bill for
exams and x-rays related to treating sleep
apnea or any other medically covered dental
treatment. All covered prescriptions ordered
will be processed under the
members Part D coverage as well as
referrals to other Medicare providers for
Medicare covered services.
Part B ordering and referring only. You can
NOT bill for any treatment or exams. Any
prescriptions under Medicare part D WILL
be covered as well as any referrals made to
another Medicare provider for services
covered under the plan, this
includes sleep studies.
Opt out of Medicare every two years. You can
NOT bill for any covered service but
prescriptions will be covered. You can also
refer for any services to Medicare
providers. However, you must have ALL
Medicare patients sign a private
agreement for services. Opting out needs to
be updated every two years. This ABN
form is likely to scare off your dental
patients as it appears to tell them that they
will not be able to use their Medicare
benefits in your office. This of course is
false since Medicare does not cover dental
services. This option has the most
paperwork that must be provided to
each Medicare patient.
Some common questions are “If I have
opted out of Medicare does that cover me for
DME as well?” The answer is “yes”, you are
opted out of all Medicare plans. Another is “If
I have opted out can I change my mind before
the two years are up?” The answer is “no.”
Unfortunately you have to sit out of the game
until your opt out anniversary is up and then,
yes, you can choose to become a provider or
opt out again.
GoGo Billing has been credentialing dentists
for over 5 years and we have seen an
increase in processing time. The fingerprint
card pushed application turnaround time from
60 to 90 days to 120 days now. With a huge
influx of applications Medicare is likely to see,
we foresee this problem becoming larger. The
sooner you get started the better! Follow the
link to sign up and start the process today!
Enter DS3100 to receive $100 off DME and
Part B provider credentialing.
If you want my 2 cents (which is worth a heck
of a lot more than that!), my suggestion to
offices would be to become a
non-participating DME provider and either
‘Part B non-participating’ or ‘ordering and
referring only.’ This suggestion comes with a
heavy warning…DOCUMENT,
DOCUMENT and, yes, you guessed it
DOCUMENT. When working with
Medicare, you are entering into a contract.
DS3 is the fool-proof way to ensure you are
following all the guidelines and your treatment
is documented safely in a cloud-based
software. Medicare requires providers use an
Electronic Medical Records (EMR) system
and electronic filing for claims. GoGo and
DS3 are the perfect solution to take your sleep
practice to the next level and accommodate a
very large Medicare population wanting and
needing your services.