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Medicare FAQs

Providers are still confused about Opting INTO Medicare and are unsure if it is the right decision. Please review these FAQ's below before you choose to do NOTHING or consider Opting OUT

What is Medicare Parts B?

Medicare is a federal health insurance program for people 65 years old or over and for certain disabled people under 65 years of age. Medicare pays for many healthcare services rendered by enrolled providers including dentist and oral surgeons.

How do I know if I treat Medicare patients?

Most dental providers think they do not treat Medicare patients however if you are treating patients who are over 65 years of age, or under 65 years of age and mentally or physically disabled, you ARE treating Medicare patients. This means the Final Rule published by CMS (Centers for Medicare Services) means serious changes for your practice, and ignoring it, or choosing to Opt OUT can cause a negative impact on your practice.

If Medicare does not cover dental procedures why should I opt INTO Medicare?

Dental providers need to understand there are certain procedures that are performed by dentist that Medicare Part B will reimburse for such as, reconstruction of the jaw, trauma from an accident, injury or disease, preparation for radiation treatment, FDA approved Sleep Apnea appliances, also for oral examinations deemed medically necessary, preceding or caused from certain medical conditions. These are procedures being performed daily in dental practices.

Why should I opt into Medicare?

  • Continue to receive reimbursements from Dental Insurance carriers
  • When properly billing cases to Medicare Part B AND / OR Private Medical Plans (PPO) that are medically necessary you will have a significant increase in reimbursements increasing your dental practice revenue
  • Avoid your patients being denied to have prescriptions filled that are written by you
  • Avoid loss of revenue and patients

What if I choose to Opt Out?

  • Loss of Patients to neighboring providers
  • No more reimbursements from Insurance carriers for senior patients and patients whose plans are governed by Medicare by major Dental carriers such as Delta Dental, Aetna, Humana and Liberty Dental insurance
  • Must remain Opted Out and locked out of Medicare reimbursement for a period of two years
  • Must notify patients in writing you are NOT a Medicare provider, and they agree to pay out of pocket for services Rendered and prescriptions

Will I have to see senior patients?

No a lot of providers think Medicare is Medi-cal / Medicaid. Medicare is a Federal health plan where as Medi-cal / Medicare is a state funded program. When you enroll this just protects your patients from having to pay list price for prescriptions, and now enables you as the dental provider to be reimbursed for medically necessary procedures that are NOT covered by dental insurance but ARE covered by Medicare.

If You Don't Make A Choice...

If you do nothing at all, your patients are at risk of their prescriptions written by you being rejected and having to pay list price. You risk losing patients when they realize you are not opted IN when they receive notice from Medicare, meaning you cannot provide proper treatment plans because they will have to pay for services that Medicare will cover.

If you do nothing you must inform your patients that they may have challenges when attempting to fill prescriptions you prescribe. It is the Dental providers responsibility to notify patients that you have either opted OUT or not made a choice, and that certain procedures you perform will not be covered.

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