By June 1, 2016, dentists must register as a Medicare
ordering/prescribing provider of Part D prescription drugs for your
Medicare-eligible patients or opt out of the program. Just what does that mean for your
practice? There is much more at stake
here than whether or not prescription drugs you prescribe for your
Medicare-enrolled patients will be covered.
If you do not register with CMS (Centers for Medicare and
Medicaid Services) or formally opt out of the program, your patients, your
practice, the pharmacy filling prescriptions for your Medicare patients, the
labs and specialists to whom you refer Medicare patients, durable medical
equipment suppliers who might supply a sleep apnea device you order for a
Medicare patient, etc., will not be
paid by Medicare. Incidentally, OPTING OUT as a Medicare provider
requires action by the dentist---it is not
the same as doing nothing.
In summary:
- If you do not register with CMS or formally opt out, drugs you prescribe for your patients enrolled in Medicare normally covered under Part D or Medicare Advantage plans will not be covered.
- If you do not register with CMS or opt out, you will be unable to submit claims to Medicare Advantage plans, some of which do cover dental services. Further, your Medicare patients cannot receive payment from their Medicare Advantage plan either. And if you choose to opt out, neither you nor your patients can submit claims to their Medicare Advantage plans.
- If a dentist takes no action by June 1, specialists and oral pathology laboratories to which you refer Medicare patients will not be paid by Medicare. Ditto for imaging services and durable medical equipment suppliers.
- If a dentist chooses to opt out, he/she must complete an affidavit to be sent to all Medicare contractors with whom he/she works. If a dentist complies with opting-out procedures, specialists, laboratories, service and supply providers to whom Medicare patients are referred will receive payment from Medicare. Additionally, Medicare patients can get their Part D prescription drugs covered by Medicare.
The easiest way to register with CMS is to complete CMS Form 8550 to become an
“ordering/referring provider.” The
alternatives are: (1) to register as a
“Medicare Provider” using CMS Form 8551
or (2) to formally opt out of the program.
(Note the method and consequences of opting out listed above.)
These regulations, part of the Affordable Care Act (Obamacare is the commonly used name.),
squeeze dentists between a rock and a hard place---either enroll as Medicare
prescribers or providers which means they agree with rules, regulations, and
guidelines of Medicare and can, therefore, be audited at any time by Medicare
agents or forfeit the use of
Medicare Advantage plans for their patients dental care, prescriptions,
referrals, oral pathology work, etc.
Currently there is a bill active in Congress, H.R. 4062, that
would exempt dentists from having to enroll in the Medicare program in order
for prescriptions for Part D covered drugs to be paid under Medicare. Suggestion: contact your U.S. Congress member to urge passage of the bill.
For additional information about enrollment/registration
procedures or opting out of the program, go to Success.ADA.org/en/practice/medicare. Move on this before the June 1
deadline!
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