The Medicare Decision Dentists Have To Make Now January 19 2015

(UPDATE: The Medicare Decision has been pushed forward until January 1st, 2106. This is still time sensitive)

The Medicare Decision Dentists Have To Make Now

As has been widely reported in dentistry, Medicare is requiring dentists to take action by June 1, 2015 to either opt in or opt out of Medicare. With this deadline, it now becomes a very real decision process that has to be made now.  With nearly 50 million people in the United States with Medicare, dentists should take a real look at their practice to make it appealing to this huge and growing patient population. How fast is it growing?  Baby boomers are turning 65 years of age at a rate of 8000 people a day.

Do you want these geriatric patients in your practice?  I sure do.  Why?  Because today’s geriatric patient demographic owns 70% of the wealth in the US, has an average income of approximately $74,000, and does the most implant, restorative, and esthetic dentistry of any other patient demographic.  The reason is they have the time, money and the teeth to work on, more than ever before.  You can now see how this becomes a very important decision as the right decision can really grow your practice and get you many more new patients.  The wrong decision will cost you time, money, prevent many elderly patients from ever considering your office, and will cause these same patients to leave your office right now.  

A decision should not be made on this simple synopsis below, there are serious considerations for each practice.  This decision is very practice specific and if you haven’t already made a decision as to what path you want to take, it is imperative that you now do so.  At this point in time, you may still be able to make the Medicare deadline of June 1, 2015, so that there will be no interruption for your Medicare eligible patients regarding being reimbursed for their Medicare Part D prescriptions, imaging, biopsies, or other services that a dentist may prescribe for patients. 

Here are the options in quick synopsis form:

  1. Do nothing: If you do nothing, you may think this decision will not affect your practice and you couldn’t be more wrong.  The major change is any patient that has Medicare (which is most patients over 65 years of age) will not be reimbursed for any prescriptions that you write for them nor will they be reimbursed for any biopsy you may send them for.  If you know anything about geriatric patients, they will not look kindly on your office once they are surprised at the pharmacy.  Even more so, with the incredible rise of dentists referring patients for diagnostic imaging,  that too will not be reimbursable to the patient because you chose to do nothing.  Imagine the surprise on your patient’s face when they see they are not getting reimbursed because your office chose to do nothing.  I am sure you will hear from these irate patients who then will leave your office in a hurry.
  2. Opt out of Medicare: This option is not the same as doing nothing.  Most dentists make the mistake thinking that opting out means you have no relationship with Medicare and don’t have to do anything.  Nothing could be further from the truth.  The opt out option has the most continual relationship and paperwork over the long term, interrupts your patient workflow, requires Medicare patients to sign an intimidating document, and requires your office to do a lot of explaining to patients.  You also must opt out again after a two year period of time.
  3. Opting In for Billing: This is a good option for dental practices that would like to bill Medicare for Part B services.  There are very few dental services that fall under Medicare Part B so this option may not be best for dental practices unless they treat a number of oncology patients or perform a lot of surgery.  Other choices that must be made with this option is whether to be a participating provider, accept assignment, and accept Medicare approved payment in full.  Because many Medicare patients also have secondary insurance, that must be billed as well.
  4. Opting In for Prescribing: Also known as enrolling for ordering and referring, this option is a good choice for many general dental practices.  As an ordering and referring provider, dentists will be placed on the Medicare Ordering and Referring Registry and will be able to prescribe medications as well as order and refer patients to Medicare enrolled providers and suppliers (such as blood tests, imaging, and the like) that will be reimbursable because you chose this option. 

Remember that these choices only relate to Medicare Part B.  This has nothing to do with Medicare DME (durable medical equipment) which relates to oral appliances for dental sleep medicine.  Dental sleep medicine only when coupled with bruxism therapy is an area every dental office should seriously look into and integrate into their practice.  This is an area that Medicare and medical insurances will reimburse and the reimbursements are well worth your time and effort and patients get the treatment they need for obstructive sleep apnea which is what causes patient’s bruxism.  Once dentists make the application for one of the options above, it is a great time to apply for Medicare DME which will save you both time and money as each application is tedious and can be confusing.  This is why it is very important to have experts help you make this decision and complete and follow your applications.

The application process is tedious and confusing.  Being that the application process no matter what you decide will take 2-6 months and if the application is not correct the first time, it will be delayed even more.   You can see that June 1, 2015 will be here very quickly.    You better make the decision a good one.  There is no question that most dental practices should not go this alone.  The choice of which direction, application and provider status to choose requires careful evaluation, education, and professional assistance. 

For my own practice, we used the enrollment professionals at STATDDS to guide us and submit our application now to make sure we don’t lose our patients who are 65 years and over.  For those of you who are wondering, after consulting with the STATDDS Medicare specialists, the option I chose for my own practice was number 4 above.  Because we enrolled early, we have already received our determination letters from Medicare and we don’t have to worry about the impending deadline.

As you can see, this is a career decision, a business decision, and also largely a very important practice and patient management decision.  The right decision here can also be a very powerful marketing tool, increase your productivity, and help you retain and recruit many new patients to 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).  You can contact him at 800 952-0521 or email   Go to where you can find information about live patient Frontline TMJ/Orofacial Pain training, Frontline Dental Sleep Medicine, Bruxism Therapy and Medical Insurance, Botox and dermal fillers training, download his resource list, and sign up for a free monthly e-newsletter.