Update: Medicare Opt In and Opt Out Requirements for Dentists

The Centers for Medicare and Medicaid Services (CMS) has extended the deadline for Medicare Part D ordering/referring providers to opt in or opt out to Feb. 1, 2017. Why is this important? Dentists who treat Medicare patients must either enroll in the Medicare program or opt out to ensure tests, procedures, devices and drugs ordered for Medicare patients will be reimbursed, as well as prevent denial of reimbursement for other providers you refer patients to. Currently, this requirement applies to the federal MediCARE plans (generally senior and disabled patients) as opposed to the state-based MediCAID plans (for low-income patients).

Despite the deadline extension to Feb. 1, 2017, CMS is urging those who fall into this category to opt in or opt out by Aug. 1, 2016, to allow sufficient time ahead of the enrollment deadline for the government to process applications. Details regarding enrollment options are available in the materials in the “Helpful Resources” section below.

Additionally, efforts are underway to remove the enrollment requirement entirely. The ADA is working in Washington, D.C., on H.R. 4062, the Protecting Seniors Access to Proper Care Act, which would exempt dentists and other non-physicians who write prescriptions for Part D beneficiaries from the enrollment mandate. You can write your members of Congress to urge them to support H.R. 4062.

Already, the ADA has been successful in working with the federal government to reduce some of the regulatory hurdles in the Medicare enrollment process. Dentists who opt in to Medicare as ordering and referring providers will not have to revalidate their credentials every five years. Dentists who opt out are not required to resubmit opt-out forms every two years. Only dentists who opt in as full Medicare providers are required to revalidate.

For dentists who opt in as ordering and referring providers (generally dentists who bill and receive payments from Medicare Advantage Plans), the federal government is working to update the form to include a box for dentists to check under the “Physician Specialty” subsection. For now, they recommend using the “Other” category and writing in the word “Dentist.” Again, dentists who opt out of Medicare will not be able to bill patients who receive dental care through Medicare Advantage Plans, nor receive payment from these plans. More details on treating patients who have Medicare Advantage Plans are provided in the “Helpful Resources” section below.

Once you have made your decision on opting in or opting out and filed the relevant paperwork, you should receive two acknowledgments—one after your application is filed and a final notice by phone or email once the process is complete. You should be able to get application status updates by calling Novitas, Colorado’s Medicare administrator, at 855-252-8782, Option 4.