By Christian Worstell, BA
Improper Medicare billing costs the federal program tens of billions of dollars every year.1 But it isn’t just the federal government or Medicare’s private sector carriers that are affected. Inefficient billing and coding practices may also mean that health-care providers are leaving money on the table.
Medicare already reimburses at rates that are lower than traditional private insurance, so dentists can’t afford to have any more pennies slip through your hands. While Medicare billing practices have many parallels to that of the private sector, the program has enough nuances to trip up even the most experienced dental biller.
5 Medicare billing tips
1. Verify benefits
Because original Medicare (Part A and Part B) does not typically cover any dental services, many older patients are likely to have a Medicare Advantage plan that includes dental benefits. The benefits of these plans vary from one policy to another, and they all have different cost-sharing structures and terms of service. Being proactive in verifying a Medicare Advantage plan’s benefits and eligibility can reduce your chances of drawing a denied claim. Confirm policy effective dates, obtain prior authorization if needed, and verify the patient’s out-of-pocket requirements under the plan.
2. Use the Medicare Beneficiary Identifier (MBI)
Beginning in 2020, Medicare did away with using a beneficiary’s Social Security number for billing purposes. Dentists must now use the 11-character alphanumeric MBI when billing Medicare. Failure to use the MBI, or even a failure to enter it correctly, could result in a rejected claim.
The MBI uses numerals 0-9 and uppercase letters only. The letters B, I, L, O, S, and Z are not used, and no hyphens or spaces should be included when entering the MBI on a claim form. Also, replace the Social Security number with the MBI in patient records.
3. Wait on the Part B deductible
If you accept Medicare assignment, the Centers for Medicare & Medicaid Services (CMS) recommends not charging or collecting the Medicare Part B deductible amount from a patient until you can confirm whether or not it has been met. The reason for this is that if you end up over-collecting, the CMS may consider this abuse, and it could lead to part of your reimbursement check being sent to the beneficiary. Or you might face a demand letter from the Medicare Administrative Contractor (MAC) outlining a repayment request. Neither are good for your bottom line.
4. Know the Stark Law changes
You may be familiar with the Stark Law, which prohibits you from referring Medicare and Medicaid patients to entities with which you have a financial relationship. But are you familiar with the changes to the law that went into effect in January 2021? Brush up on the changes to see how the new regulations can create more streamlined revenue opportunities for your practice.
5. Remain up-to-date on coverage determinationsWhat’s covered or not covered by Medicare is largely in the hands of Local Coverage Determinations, National Coverage Determinations, and Medicare Administrative Contractors. Staying in the know about these coverage decisions can help you better shape the service offerings of your practice. Signing up to receive CMS listserv updates can help keep you informed.
Better billing means a bigger bottom line
If you don’t have many Medicare patients, it can be easy for your administrative team to fall out of practice with Medicare billing. Whether you’re training a new biller or retaining a seasoned veteran, it never hurts to conduct an annual Medicare billing best practices refresher. More efficient Medicare billing leads to more streamlined operations, a bigger bottom line, and bigger smiles on the faces of your older patients.
1. Error rate drops, but Medicare still lost $31.6 billion to preventable billing errors in FY2018. Council for Medicare Integrity. November 20, 2018. https://medicareintegrity.org/error-rate-drops-but-medicare-still-lost-31-6-billion-to-preventable-billing-errors-in-fy2018