Time to act now- the Medicare deadline is here!

Look how fast time goes. Nearly a year ago, the ADA told dentists about the deadline to make a decision about Medicare. Dentists learned they would need to take action and submit an application by June 1, 2015, to either opt in or opt out of Medicare. It's incredible that I still meet dentists every day who tell me they didn't know they have to make a decision. Most dentists are now waking up in panic mode realizing how much they have procrastinated. It's time to act now!

Louis Malcmacher, DDS, MAGD

Look how fast time goes. Nearly a year ago, the ADA told dentists about the deadline to make a decision about Medicare. Dentists learned they would need to take action and submit an application by June 1, 2015, to either opt in or opt out of Medicare. It's incredible that I still meet dentists every day who tell me they didn't know they have to make a decision. Most dentists are now waking up in panic mode realizing how much they have procrastinated. It's time to act now!

Certainly the deadline is here, and dentists have only a few weeks to make the decision and submit a Medicare application. This is very important because the right decision can really grow your practice and gain you many new patients. The wrong decision will cost you time and money, prevent many elderly patients from considering your office, and cause these same patients to leave your office.

Over the past year, in my lectures and patient training courses for over 10,000 dental professionals, I have heard many of the missteps that have happened to dentists concerning this Medicare decision. I also called on the STATDDS Medicare specialists to ask what their experience has been with dentists over the past year. Here is a compilation of some statistics that I hope can help dental professionals make this important Medicare decision:

STATDDS statistics:

1. Ninety-seven percent of STATDDS dental clients chose opting in for enrollment. This option, also known as enrolling for ordering and referring, is the best choice for most dental practices, which is why it is the most popular. As an ordering and referring provider, dentists will be placed on the Medicare Ordering and Referring Registry. They 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 they chose this option.

2. Two percent of dental clients chose opting in for billing. These practices provide services that can be billed to Medicare and medical insurance. These are usually oral surgery practices or hospital-based dental practices that routinely treat major trauma and head and neck cancer patients. These dental practices also had to make choices regarding whether to be a participating provider and accept assignment, and they will have to bill patients' secondary insurance.

3. One percent of dental clients chose to opt out of Medicare. The opt-out option has the most continual relationship and paperwork over the long term. It interrupts patient workflow, requires Medicare patients to sign an intimidating document, and requires your office to do a lot of explaining to patients. Dental practices are opted out for two years and are locked out of Medicare Part C (Medicare Advantage plans), some of which carry dental benefits.

4. Thirty-seven percent of STATDDS Medicare application dental clients also submitted a Medicare DME application at the same time for convenience and savings. If a dental office already offers oral appliances for dental sleep medicine, or will in the next two to five years, then it makes sense to go through the DME application at the same time.

DIY or outsource?

When I lecture about Medicare and dentistry, I often get the question, "Can I do this application myself?" I answer with this analogy. If a pipe bursts in my house, I can fix it, but it will take me all day, I will do it wrong the first few times, and I will have to hire a plumber eventually to fix it correctly. I have been trained in laboratory work, so I can do my own lab work. Why don't I (like most dentists) do my own dental lab work? Because someone else can do it faster, better, and ultimately for less money than I can. I don't get paid for doing lab work. I get paid to deliver dental services. That is my core business. Anything that takes me away from my core business of dentistry costs me money. Add that I don't have the necessary expertise when things go wrong, I'm forced to waste a lot more time and money than if I had outsourced this to a professional in the first place.

The same thing applies to this Medicare application process. I know many dentists have tried to go through the application process themselves. One little thing is filled out incorrectly, the application is rejected a couple of times (Medicare may not tell you where the mistake is), and dentists have a real mess on their hands. How much is a dentist's time worth? Should a dentist waste their time slogging through the application? A few office staff members have told me they collectively spent about 40 hours on the application process and received a few rejections, and they have no idea what to do or how to know if their application is accepted. In lost production, this can cost an office $1,000 to $1,500, much more than letting professionals handle it.

Expensive mistakes

Other miscues dentists have reported concerning the Medicare decision because they did not get professional help include:

• Some dental associations have told members to opt out without fully understanding the implications. A number of dentists in a particular state opted out of Medicare and were then locked out of Medicare Advantage dental plans, which they had previously accepted and were happy with. These dentists are now locked out of these plans with good reimbursements for two years and will directly lose patients who will not be back once this lockout is over.

• Some dentists make the erroneous assumption that if they do nothing, their patients won't care. They believe this is only about patients' ability to be reimbursed for Medicare Part D prescriptions, which are cheap anyway. This is a huge mistake. This affects patients' ability to be reimbursed for their prescriptions, or if you refer them for a biopsy, imaging, or any procedure that Medicare may pay for. If you know anything about Medicare geriatric patients, if they're told they have to pay even a small fee for a prescription because their dentist messed up, they will leave the office. For every dentist who tells me they don't care, I tell them to send the patients to my office. Medicare patients are doing more dentistry than ever before, and I'm happy to welcome them to my office.

• Some dentists have mistakenly opted in for billing Medicare when this is not a good choice for their office. There are some minimum billing requirements they may not be able to meet, at which time Medicare will deactivate their account.

• Many dentists think "opting out" is the same as having nothing to do with Medicare. They now realize that was a poor decision, and they have had a ton of paperwork added to their daily dental practice that they didn't see coming.

• Some dentists waited to process a separate Medicare DME application, which cost them more money than bundling everything together.

I ask dentists if they do their own accounting or legal work. No, they don't. This Medicare application process takes a certain level of professional skill and expertise that I guarantee you and your front office staff do not possess. The choice of which direction, application, and provider status to choose requires careful evaluation, education, and professional assistance. For my practice, we used the professionals at STATDDS to guide us and submit our application to make sure we don't lose our 65+ age patients.

For those of you wondering, after consulting with the STATDDS Medicare specialists, the option I chose was to opt in for enrollment/prescribing. Because we enrolled early, we've already received our determination letters from Medicare, and we don't have to worry about the impending deadline. We also submitted a Medicare DME application at the same time. This saved us money, and more importantly, time. Using the STATDDS home bruxism and sleep monitor, our office has quadrupled the number of bruxism appliances, and we provide oral appliances for dental sleep medicine at a fee range of $2,000 to $4,000. Being a Medicare DME provider significantly increases the number of these appliances our office will provide.

As you can see, this is a career decision, a business decision, and a very important practice and patient management decision. The right decision can also be a very powerful marketing tool, increase your productivity, and help you retain and recruit many new patients. You need to make the decision now; time is running out. Outsource this to professionals, get your Medicare applications done right, and get them done today!


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). Contact him at (800) 952-0521 or drlouis@FacialEsthetics.org. Go to www.FacialEsthetics.org to find information about live patient frontline TMJ/orofacial pain training, frontline dental sleep medicine, bruxism therapy and medical insurance, and Botox and dermal fillers training; to download his resource list or sign up for a free monthly e-newsletter.

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