News

Previous   Next

08/12/2014

Important Info on Medicare and Patients

Beginning on June 1, 2015, patients with Medicare Part D drug coverage will receive reimbursement for prescriptions only when they are issued by doctors who are enrolled or “opted-out” as Medicare providers. As a result, dentists who treat Medicare beneficiaries should either enroll or opt-out of the Medicare program in order to prescribe medication to patients with Medicare Part D drug plans.

 

The Centers for Medicare and Medicaid Services published a final rule in May 2014 that requires all physicians and other eligible professionals who prescribe Part D covered drugs to be enrolled in Medicare or opt-out for those prescriptions to be covered under Part D. As the ADA advises, by signing an affidavit opting out of Medicare and entering into private contracts with patients as appropriate, dentists agree to opt-out of Medicare for a period of two years and cannot receive any direct or indirect Medicare payment for services provided to Medicare patients.  

 

Dentists who do not take any action are likely to be subject to complaints from their patients and local pharmacies that they are not being reimbursed for prescriptions written by the dentist.

 

Medicare enrollment & opt-out:  https://www.ada.org/en/member-center/member-benefits/legal-resources/publications-and-articles/reimbursement/medicare-enrollment-decision-tool-introduction-medicare-enrollment

 

Sample affidavit form:  https://www.ada.org/en/member-center/member-benefits/legal-resources/publications-and-articles/reimbursement/opting-out-of-the-medicare-program

 

Information regarding “opting-out” of Medicare:  http://www.cms.gov/Outreach-and-Education/Medicare-Learning-Network-MLN/MLNMattersArticles/downloads/SE1311.pdf

 

General website for Medicare:  http://cms.hhs.gov/Medicare/Medicare.html