Changes in enrollment deadline for Medicare

The Centers for Medicare and Medicaid Services (CMS) has announced that the new compliance date for enrollment or opt out for dentists to the Medicare program is Jan. 1, 2016.

The original deadline was June 1. 

While dentists have an extra six months until the new compliance date, CMS cautions that it will take four to five months to process enrollment and opt-out forms. Dentists are encouraged to consider June 1 as a soft compliance date to get their forms in so as not to have their status or patient benefits lapse while forms are being processed.

Dentists who want to know more about their options for either opting in or out can read this article from February.

CMS has clarified that dentists who opt out will not be able to submit claims to Medicare Advantage plans for Medicare patients’ dental benefits. If a practice has a number of patients with dental coverage through Medicare Advantage, and intends to bill those plans, a CMS Form 855o should be submitted to become an ordering/referring provider.

CDA has received a number of questions about whether Medicare will reimburse for providing patients with sleep apnea appliances. The answer is “yes,” but Medicare will only pay for a Herbst appliance. Other types of appliances will need to be recognized and approved by CMS. To obtain reimbursement for providing this appliance, a dentist would need to be enrolled as a durable medical equipment (DME) provider, and that would require submitting a CMS Form 855s. Dentist becoming a DME provider cannot opt out, and must enroll using the 855o form to extend prescription benefit to patients and to be reimbursed for sleep apnea appliances.

For more information on Medicare enrollment options, dentists can contact Noridian Healthcare Solutions, Provider Enrollment, at 855.609.9960.

For more information on the enrollment deadline, contact CDA Practice Support at 800.232.7645.

Related Items

Dentists need to ensure that their practices are prepared for dental procedure code changes that go into effect Jan. 1. There are 73 code changes, including 16 new procedure codes. The ADA released the latest version of the Current Dental Terminology (CDT) Codes earlier this year.

Deadline to opt in/out as Medicare provider
By Ann Milar, CDA dental benefits analyst
There are two important reasons why dentists need to pay attention to upcoming changes and understand the potential impact to dental patients and one's dental practice. First, with 35,000 licensed dentists in California and more than 5 million Californians enrolled in Medicare, simple arithmetic shows that there are 143 Medicare patients per dentist in the state. Secondly, CMS issued a recent rule requiring all physicians and eligible professionals — including dentists — who prescribe Part D-covered drugs to be enrolled in Medicare or opt out for those prescriptions to be covered under Part D by June 1, 2015.