Thursday Troubleshooter: Medicare – to opt in or opt out?

There are advantages and disadvantages to opting in or opting out, but both choices bring with them plenty of paperwork and hoops to jump through.

Oct 30th, 2014
Medicare For Dentists 1

QUESTION: We are a general dentist practice in N.C., and we’re trying to decide what to do regarding Medicare patients. If we opted out, would Medicare patients get prescription coverage, which we would prescribe, say, in the case of an antibiotic premed for artificial joints? Also, would someone be covered if they presented with an abscessed tooth and we prescribed an antibiotic and possibly pain medication? My second question is, if we opted out, would we be able to file a Medicare advantage dental claim on a patient’s behalf for their reimbursement? We are a small practice and do not participate in any dental programs. Thank you for your time.

ANSWER FROM DR. LOUIS MALCMACHER, Common Sense Dentistry Educational Dental Seminars: (Dr. Malcmacher contacted the STATDDS Medicare Enrollment Experts at STATDDS.com.)
Question 1 – If you opted out, yes, the patients would be able to be reimbursed for their medications at the pharmacy. The bigger question is whether it is right for your office to opt out, as this requires the most continuous paperwork for your office and the requirements must be followed very precisely. Opting out does not mean your office has no relationship with Medicare. If anything, opting out is a very complicated option.
Question 2 – This depends on the plan. Some would allow you to bill these plans if you opt out, and there may be the occasional plan that would not allow it. Hope this helps!

ANSWER FROM CHRISTINE TAXIN, Links2Success Dental Consulting:
At this time all dental offices need to become a part of Medicare as a registered provider. This does not mean you are in network. However, if you choose to be in or out, you need to put that application in every two years. With the prescription rules, this keeps you on record for patients who are ordering prescriptions for any reason, and in order for the patients to receive that prescription as a covered benefit, it has to be written by a provider who is registered. If you have patients with other insurances that are their Medicare benefits, such as Aetna, you can be out of network with Medicare and in network with them for treatment. However, all of the plans will hold you responsible for your registration on the Medicare list. I hope this helps.

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