Smart Providers Opt Into Medicare

Kathy Moore and Denise Balestier (Jones)
Image courtesy of stockimages at


Image courtesy of stockimages at

Dental providers are receiving notices from major dental carriers and from the Centers for Medicare and Medicaid (CMS) telling them to enroll as Medicare providers. If these dental providers do not enroll as Medicare providers, their Medicare age patients will not be able to obtain the medications prescribed by them, nor will medically necessary procedures be covered.

Many dental providers have ignored this mandate. Some providers say that they don’t accept Medicare. These providers aren’t paying attention that if they treat patients over the age of 65 or disabled patients, both adult and pediatric, they are treating Medicare patients.

The August 1 deadline for dental providers to enroll in or choose to opt out of Medicare is quickly approaching. If you have received a notice from CMS stating that you have written prescriptions for Medicare Part D patients, you should opt in as a provider as soon as possible. Providers who opt in also will be able to bill Medicare for medically necessary procedures as indicated by the primary medical carrier, Medicare.

Providers who choose to opt out will have to notify their patients that they will be subject to paying list price for medication prescribed by them. When opting out, you must have your patients sign a contract stating they agree to pay for certain medically necessary procedures that Medicare or their private plans may cover.

Opting out also means you might not be an in-network provider for some dental plans any longer and risk losing reimbursements as well as patients. If you have an all-cash practice that does not bill insurance, you may want to consider completing an ordering and referring application in case you have to write a prescription for a Medicare patient.

Today’s dental practices also need to become familiar with the medical billing process. Over the past decade, research has exposed a relationship between oral infection and systemic health conditions, causing dental professionals to look more closely at the link between a patient’s health and overall physical health.

There are several advantages to filing medically related dental services with medical claims, such as more coverage for your patients and higher reimbursement for certain procedures. New standards are in place for many procedures, and dental practices are recognizing the value of filing medical claims for them.

You will see increased case acceptance for those procedures that fall under the guidelines for medical coverage, even from those patients who have dental insurance. Your patients will see billing for medically related dental procedures to their major medical plans as a value-added service.

Kathy A. Moore, MBA, is the owner of Moore Martini Medical and has over 29 years of experience in the medical and dental fields. Prior to forming Moore Martini Medical, she worked as a corporate trainer and senior sales representative for Kendall Healthcare Products-Tyco; senior sales representative for MetPath Laboratories; senior sales representative for Regent, Inc.; and area sales manager for SRI/Surgical. She earned her MBA from JFK University with an emphasis in sales and marketing. She is also a member of the American Association of Professional Coders (AAPC). She can be reached at



Denise N. Balestier (Jones) is an implementation/training coordinator with Moore Martini Medical. She coordinates compliance implementations and seminars pertaining to Medicare, medical billing regulatory requirements, and compliance in dental practices. Previously, she was the vice president and chief operating officer of TheIBNetwork. She can be reached at




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