How
are you handling Medicare? Have you OPTED out yet?
More than two years have passed since the latest
Medicare reforms became effective allowing dentists
to formally opt out of Medicare.
Prior to February 8, 2004, federal law required dentists
to obtain a Medicare provider number and submit dental
claims on a CMS 1500 medical claim form if a Medicare
patient insisted he/she do so.
Since most dental services are statutorily excluded
under Medicare, many dentists have decided to simply
ignore the opportunity to opt out.
Unfortunately, those who perform biopsies and provide
sleep apnea and/or TMJ appliances often learn the
hard way that some dental-related services are not
statutorily excluded from Medicare.
If a dentist has not formally opted out of Medicare
and entered into private contracts with patients,
he/she is required to enroll in Medicare as a participating
or non-participating provider and submit claims if
requested by Medicare patients. The failure to opt
out comes at an additional price because enrolled
dentists must accept the Medicare limiting fee schedule,
which is often a substantial reduction from the dentist’s
full fee.
Medicare recognizes that seniors can be easily exploited.
As a result, Medicare requires dentists to provide
Advanced Beneficiary Notices (ABNs) if they have not
formally opted out of Medicare. ABNs inform Medicare
patients in advance of treatment if a service may
not be covered by Medicare.
If treatment-specific ABNs are not provided to Medicare
patients, dentists are not allowed to charge patients
for non-statutorily excluded services that are denied
by Medicare.
For more information regarding a dentist’s
federal obligation under Medicare, send an e-mail
to Insurance Solutions attn: amds@ncfweb.net
with “Medicare” in the subject line.
