Medicare
Choices
rules & regulations
FOR YOUR DENTAL PRACTICE
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 prescribing 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 prob-
lems when making referrals or prescribing treatments or medications to their Medicare patients.
The Opt In/Opt 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
22 NORTH TEXAS DENTISTRY | www.northtexasdentistry.com
area. There is also a third option for providers to apply as a
Medicare ordering and referring provider (see below).
Why Opt In or Opt 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 clinics 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 online, including the ability to submit accompanying
documents. Clinics must agree to accept set payments for
Medicare reimbursement. They must also demonstrate that