06/15/2015

Medicare provider enrollment date pushed back again


The federal Centers for Medicare and Medicaid Services (CMS) has again changed the compliance date for dentists desiring to opt out of the Medicare program. The new date, June 1, 2016, comes within a month of CMS moving the date from June 1 of this year to Jan. 1 of next year.

The opt-out from Medicare allows dentists to formally notify CMS that they do not wish to participate as a provider within Medicare, do not intend to submit claims to Medicare (and Medicare does not pay for basic dental care), and yet as an opted-out provider, prescriptions ordered will be paid by Medicare. That is the key advantage to opting out from the Medicare program.

CMS has notified interested parties that it will take four to five months to process all the forms coming in for Medicare participation, whether they opt in, opt out or register as an ordering and referring provider. What the compliance date of June 1, 2016, means is that for the dentist who has submitted an opt-out affidavit well in time for it to be processed by June 1, 2016, Medicare will be paying for prescriptions on and after June 1, 2016. Dentists may submit an opt-out form, or other provider status form, after June 1, 2016, but on that date Medicare will not be paying for medications prescribed by a dentist unless the opt-out affidavit has been received and processed prior to the compliance date.

For additional information on the Medicare enrollment options, click here.



Related Items

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. 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 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.

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