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Dentists must choose to opt in or out of Medicare enrollment

June 16, 2014
By Kelly Soderlund
Any dentist who treats Medicare beneficiaries must either enroll in the program or opt out in order to prescribe medication to their qualifying patients with Part D drug plans, according to the federal government.

Either way, dentists who fit this requirement must take action by June 1, 2015. They either have to opt in or opt out.

The Centers for Medicare and Medicaid Services published a final rule in May that requires 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 signing an affidavit opting out of the program, and entering into private contracts with patients as appropriate, dentists are out of Medicare for two years and cannot receive any direct or indirect Medicare payment for services provided to Medicare patients.

“The policies finalized in this regulation will strengthen Medicare by providing better protections and improving health care quality for beneficiaries participating in Medicare health and drug plans,” said Marilyn Tavenner, CMS administrator. “The final rule will give CMS new and enhanced tools in combating fraud and abuse in the Medicare Part D program so that we can continue to protect beneficiaries and taxpayers.”

“Dentists who don’t take action won’t see an impact until next year but it will be when their local pharmacy or patient starts to complain that they are not being reimbursed for the prescriptions the dentist writes,” said Dr. Andrew Vorrasi, chair of the Council on Dental Benefit Programs. “We’re not sure how the pharmacies will handle this. Will they refuse to accept the prescription? Will they accept the prescription but force the patient to pay and tell them it’s because Medicare won’t reimburse the pharmacy or patient because their dentist didn’t comply with the law? How will the patients react if they file their own claim for reimbursement that is denied? While the ADA opposed this action, it is one of those situations where the decision was beyond our control. Complying with this law will save practitioners much time and aggravation come June 15, 2015.”

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