Content Dam Diq Online Articles 2015 03 Medicare For Dentists

Thursday Troubleshooter: Medicare ordering/referring provider and patient reimbursement

March 12, 2015
This dentist has done his Medicare enrollment homework, but he still can't find an answer about ordering/referring provider and patient reimbursement.

QUESTION: In all my reading about the three choices we have regarding Medicare, I haven’t been able to find the answer to my question. If I enroll as an ordering/referring provider, can my patients file for reimbursement themselves? I know if I opt out of Medicare I must have patients sign a contract agreeing not to seek reimbursement from Medicare, but I haven’t seen anything that specific for ordering/referring providers. I have a small number of patients who have the Medicare advantage plans with a dental option. I would have the patients pay up front and explain why we can’t file their insurance, but can I also let them know they can file for reimbursements themselves? Thank you for your help in this matter.

ANSWER FROM DR. LOUIS MALCMACHER, [email protected]: I checked with the STATDDS Medicare specialists on this question ( As I reported in my five-part Medicare series in Dental Economics, (visit, search Malcmacher/Medicare) there are very few services in a general dental office that Medicare will actually pay for. Most dentists would probably make less than $1,000 a year of production on Medicare reimbursed services. After overhead, this is an insignificant profit for any dentist.

Now weigh that insignificant profit against the paperwork and worry you must manage if you either opt out of Medicare or opt in for billing. You will spend more of yours and your office’s time with either of those options than you would ever profit from any of the procedures that are reimbursed by Medicare. That’s why the best option for most dental offices is opting in for ordering/prescribing as there is no paperwork involved after the initial application process.

In the rare circumstance that a patient needs Medicare reimbursable dental services after you opt in for ordering/prescribing, it is best for you to refer the patient to a provider that bills Medicare, then they’ll be covered for these procedures. It is very difficult for patients to send in a claim to Medicare themselves.

One word of caution – no matter what choice you make, hire professionals such as STATDDS to guide you through the application process. I can tell you horror stories from dentists who have tried the process themselves and messed things up for their offices. Most dentists don’t do their own legal or accounting work, and the same holds true here. Dentists need professionals to take care of this. It’s something they only need to do once, and it will definitely save them time and money.

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Send your questions to [email protected]. All inquiries will be answered anonymously every Thursday here on DIQ.