Medicare Made Easier: Changes to Opt-In/Opt-Out Process

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Dentists no longer need to opt in (enroll) or opt out of Medicare to continue to provide dental care, supplemental services, and prescriptions for patients on Medicare or Medicare Advantage plans.

Background

In 2014, the federal Centers for Medicare and Medicaid Services (CMS) issued a guideline that required dentists and other healthcare providers to either opt in or opt out of participation in Medicare. But CMS has continually delayed the enforcement date of this requirement due to concerns about the patient and provider effects of this requirement. In November 2017, after more than three years of advocacy by the American Dental Association, Medicare announced it plans to permanently rescind the opt-in and opt-out requirements for dentists. This change should help remove superfluous and duplicative paperwork and unnecessary interference for dentists in delivering requested services to patients.

What Doesn’t Change

Unfortunately, in making these policy revisions, CMS has not rescinded the two-year opt-out period for providers, meaning dentists who have already opted out of Medicare cannot bill a Medicare or Medicare Advantage plan until their two-year opt-out window expires. Dentists who have opted out of Medicare may continue to use private contracts (a formal, written agreement) with patients to provide care to these patients until the two-year restriction expires. Dentists currently under a Medicare opt-out contract can call Novitas (Colorado’s Medicare vendor) at 855-252-8782 to ensure their opt-out does not automatically renew at the end of the current two-year window.