Is it right for your practice?
by Louis Malcmacher, DDS, MAGD
Making the right decision regarding Medicare is very important for your dental practice. It is becoming well known that dentists must take action by June 1, 2015, and must either opt in or opt out of Medicare. The ADA, as well as many of its constituent societies, has been publicizing this to dental professionals. Like most people, dentists will try to wait until the last minute to even begin thinking about what to do concerning Medicare.
This will turn out to be a mistake for many dental practices. No matter what you decide to do regarding Medicare, the application process takes months to accomplish. If you miss the June 1 deadline, a pharmacist will tell many of your Medicare patients that they will not be reimbursed for their prescriptions because their dentist failed to make a choice. With this deadline, it becomes a very real decision process that must be made now. This is a very important decision because the right choice can grow your practice and gain you many new patients. The wrong decision will cost you time, money, prevent many elderly patients from ever considering your office, and cause these same patients to leave your office. This decision should be based on practice management considerations that are unique to each doctor and practice. Let's take a look at one of these options.
One of the options that dentists can choose regarding Medicare is to opt out. Many dentists I know make a knee-jerk reaction and say they want to opt out. Nearly every dentist makes a mistake when they hear the term "opt out" of Medicare, and I understand why. The term "opt out" in regular parlance sounds like you as a health-care provider choose not to be a part of Medicare, you don't want to be involved with Medicare at any level, you don't want to deal with any paperwork, and you want Medicare to leave you alone. Unfortunately, just like any insurance that you're involved in, the words Medicare uses do not mean what you think they mean. You have to learn the Medicare language to understand what "opt out" means.
Opting out of Medicare does not mean that you are free from the Medicare program. What it means, according to Medicare, is that you are opting out of the right to bill Medicare and can charge whatever fees you want to patients. You as a health-care provider are still very much in the Medicare system. As a matter of fact, as a dentist, the option of opting out creates a continuous stream of paperwork for you and your practice to maintain. Opting out requires very specific compliance requirements, which calls for a well-trained front desk and clinical staff to implement. There are rules for documentation and deadlines that must be understood and evaluated before you decide to opt out.
One more very important note: if you choose to opt out, then you are locked out for a two-year period, at which point you need to go through the opt-out process again. If upon opting out you decide this was the wrong decision, there is very little you can do other than comply with all of the opt-out regulations until the two-year period is up. A dentist cannot opt out for only certain services or patients. This is why it is crucial to understand your choices and make the right one for your practice.
To officially opt out of Medicare, you will need to file an affidavit with each applicable Medicare carrier in any region from which Medicare sees patients. Medicare is broken up into approximately 12 regions, and each has a different Medicare carrier. Your office will have to enter into written "private contracts" with patients who are Medicare beneficiaries and keep copies of those contracts on file. There is a specific timeline requirement that has to be met as well in terms of the order of private contracts, carrier affidavits, determination letters, and future opt-out applications.
The private contract form is based on the Medicare statute and CMS regulations and guidelines, which are strict when it comes to content. This contract must be printed in a large enough font size to allow patients to read it. If the dentist fails to remain in compliance with Medicare's opt-out conditions and requirements during the opt-out period, then all private contracts and the opt out are null and void. These private contracts are not filed with the Medicare carrier. You must keep the originals and give a copy to the patient before services can be provided.
The language in the private contract to geriatric patients can be scary. Think about this from an over-65-year-old geriatric mentality, from someone used to having Medicare cover everything when it comes to their health-care needs. You and I both know that Medicare doesn't cover any standard dental services. Many Medicare patients also know that. Now put this private contract that says they are fully responsible for all of their dental treatment, and that they are giving up all rights to Medicare payments in your office, etc., in front of these Medicare beneficiaries. I would bet that if I put this same form in front of many of you, you would be hesitant to sign it. The dental team needs excellent communication skills to explain these private contracts to patients.
This article is simply to inform and lay out the issues involved if you make the choice to opt out. I asked the STATDDS Medicare enrollment specialists what dentists are choosing when it comes to a relationship with Medicare. With the thousands of dental applications they have done so far, they said the overwhelming majority (98%) are not choosing to opt out for many of the reasons mentioned here. Dentists are choosing Medicare enrollment options that do not have the practice management challenges that come with opting out.
The question you have to ask is do you want more patients over 65 years of age in your practice or not? If the answer is yes, and you choose to opt out, this will certainly raise some red flags with this demographic. You need to be prepared to handle the continuing conversation your team will have when it comes to these private contracts so you can be compliant with the opt-out regulations. Opting out does not mean less paperwork; it means more. Opting out does not mean you have nothing to do with Medicare; it means you have as many compliance regulations as any other choice. Make sure you know what you are getting into.
Next month we will cover other Medicare relationship choices that may be a better fit for your practice.
Louis Malcmacher, DDS, MAGD, is a practicing general dentist and an internationally known lecturer and author. Dr. Malcmacher is president of the American Academy of Facial Esthetics (AAFE) and serves as a consultant to STATDDS. You can contact him at (800) 952-0521, or [email protected]. Go to www.FacialEsthetics.org to find information about live patient Botox and dermal fillers training, frontline TMJ/orofacial pain training, frontline bruxism therapy, dental sleep medicine, Medicare and medical insurance, and to sign up for a free monthly e-newsletter.
