Patti DiGangi

Dentistry is in transition and making the right choices can lead to higher productivity and happy patients that refer their family and friends. Isn't that what we all are looking for in our practices? Medicare can potentially open doors to new possibilities. Every dentist has choices to make about Medicare yet is probably very confused.

National Provider Number

All dentists have a National Provider Identification (NPI) number which means Medicare knows you exist. In addition, dentistry is now recognized as a branch of medicine per the Centers on Medicare/Medicaid in 2013 with their redefinition of the word physician to include 'doctors of dental surgery and dental medicine.' Medicare isn't only for those over age 65. It also covers those under age 65 with a permanent disability, renal disease and Lou Gehrig's disease. This means children, adolescents, teenagers, and many more can come under Medicare. Most traditional benefit carriers watch Medicare choices carefully and often create their plans to mirror Medicare. Dentists ignoring this information are doing it to the peril of their practice.

Opt-in, Opt-out or Do Nothing

Articles written on this subject seem to indicate that the choices are opt-in or opt-out but that is not quite accurate. Medicare is a complex constellation of choices, paperwork, approval and more. It can't readily be made into a simple 1,2,3 choice. The right choice depends on the practitioner AND the practice. No one else can decide for you. Each practitioner needs to choose.

Ramifications of Doing Nothing

In the past, a dentist did NOT have to declare their status unless they performed medical services. E.g. Sleep apnea, billing for CT scans, etc. Now EVERY dentist MUST MAKE A DECISION! Doing nothing is a choice. If you have not declared by either opting out or applying as an approved ordering and referring provider, any Rx written and referrals by you will not be covered by the beneficiary's Medicare Part D coverage because you are not a recognized provider. Should you refer a patient to another provider for any service you perform that would be covered by Medicare, the service will not be covered, Medicare does not recognize you as the referring provider as opted-out or as enrolled in the registry, therefore no coverage.

Delayed but only a little

The enrollment deadline was June 1, 2015. CMS recently moved the enforcement date to January 1, 2016. Though it feels like "whew, I have more time," delaying your decision is not a good choice. Don't wait until the last minute. There can be gold at the end of the rainbow...if you make the right choice for you, your practice AND your patients!