11/05/2018

Does the Jan. 1 Medicare deadline apply to you?

Clarification on Medicare enrollment versus opt-out

The Centers for Medicare and Medicaid Services (CMS) earlier this year published a final rule revising the Medicare Advantage program (Part C) and Prescription Drug Benefit program (Part D) regulations.  

The final rule, issued April 16, rescinds a previous CMS rule that required dentists who provide dental care and prescriptions for Medicare Advantage patients and Part D beneficiaries to be enrolled in Medicare or to have opted out in order for their services to be covered. Dentists are no longer required to enroll in or opt out of Medicare in order to prescribe medications through the Medicare Part D program or enroll in Medicare in order to participate in Medicare Advantage dental programs.

However, dentists who provide Medicare-covered items and services (clinical laboratory services, imaging services or durable medical equipment, prosthetics, orthotics and supplies) will need to either enroll in Medicare using form CMS-855-I (PDF) or the shorter enrollment form CMS-855O (PDF) or formally opt out. Medicare generally does not cover routine dental items and services. More information on dental services that may be covered by Medicare can be found on the CMS Medicare Dental Coverage website.

The ADA reports that failure to submit CMS 855O may have severe repercussions for the specialties of oral and maxillofacial pathology and oral and maxillofacial radiology, while also creating problems for referring doctors and their patients. Enrolling in or opting out of Medicare by Jan. 1, 2019, ensures that biopsies sent to pathology labs and referrals to imaging centers will be reimbursed by Medicare.

For more information about Medicare, visit the ADA’s Facts and FAQ on Medicare webpage. Access the Medicare enrollment forms.



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