If you’re like me, when dental patients mention Medicare, your head spins a bit. Most people would rather ignore Medicare than deal with it! But if your practice has Medicare Advantage patients or anyone over 65, you need to know about Medicare.
If you don’t know the basics, you risk steep fines, and you’ll limit your treatment options and income opportunities. There’s a lot of information (and misinformation) on the subject, and we’ll walk through some key points here.
Yes, dentists have to make Medicare decisions, even if you’re not a Medicare dentist. There are some basic Medicare rules that will impact your practice and one rule that can require you to file a Medicare claim if that is the type of coverage the patient has.
At Dental ClaimSupport, we have experts on the subject of Medicare that can guide dental teams through the process of filing and being reimbursed for a Medicare claim. It’s a little different than creating a regular dental insurance claim, so a little help can be useful.
In this article, we’ll explain 3 ways an outsourced dental billing company can help your practice navigate Medicare billing. This could help your practice bring in money from a pool of patients you may have not accepted previously, or you may have even accepted them but didn’t know how to get reimbursed fully.
1. You’ll more easily comply with Medicare’s mandatory filling law with help from an expert remote biller
Medicare has a mandatory filing law. The filing law states that if you provide any Medicare-covered treatment to a Medicare patient, you're required to file a Medicare claim.
For example, a biopsy is a Medicare-covered service. If your patient has Medicare benefits, and you want to perform a biopsy you have three options:
- You can enroll in Medicare, have your biller file a claim, and be reimbursed.
- You can opt-out of Medicare and not receive Medicare reimbursement, including Medicare Advantage payments. You can opt-out and write up a private contract and bill the patient to pay your fee.
- You can provide the service at no charge to the patient.
What you can’t do under this law is skip over filing your Medicare status, then perform the biopsy and bill the patient. If you're not enrolled as a Medicare provider, you cannot bill Medicare patients for services covered by Medicare.
And if you do, you’re in violation of the mandatory filing law and can be fined $2,000 per incident. Medicare administrators have discovered this practice, and you don’t want to be the next dentist who gets a violation notice.
You have to either enroll or opt-out of Medicare. The point is, you have options that are a lot safer than ignoring Medicare.
An expert outsourced biller can help you understand why you should be enrolled in Medicare Part B
A big reason an outsourced biller will tell you to enroll in Medicare Part B is so that you can treat patients covered by Medicare. To accept and be reimbursed by Medicare, you have to be enrolled in Medicare Part B.
When enrolling as a provider for Part B Original Medicare, you have three enrollment options:
- Part B Non-Participating Provider
- Part B Participating Provider
- Part B Ordering and Referring Provider
You will choose your enrollment option based on what type of services you want to provide your patients who have Medicare benefits.
Your remote biller can help you figure out what’s best for your practice.
2. The outsourced biller can help you create and submit a Medicare claim
Here’s the good news about submitting Medicare claims: they can be filed electronically, just like other dental insurance claims.
The challenge dentists have with filing electronic claims to Medicare occurs within the practice management software or clearinghouse they use. Some software programs only show you the option to produce a paper medical claim instead of an electronic version. You can always look into software specifically designed to submit Medicare claims. There are free versions available.
If your practice management software already supports electronic formats for Medicare claims - your expert remote biller should have no problem submitting a Medicare claim.
3. Get Medicare claims - (especially for sleep apnea appliances) reimbursed at the highest amounts with a remote biller’s expertise
The number of people needing treatment to help with sleep apnea is on the rise.
For dentists, providing sleep apnea appliances can provide a healthy stream of revenue. Medicare recognizes sleep apnea as a medical condition and makes coverage available.
Even better for dentists, Medicare ONLY covers the cost when the device – called durable medical equipment or DME – is provided and billed by a licensed dentist. To receive Medicare payments, a billing expert with the latest Medicare knowledge is essential to your process.
In order to provide DME for your patients who have Medicare, you’ll need a special kind of Medicare enrollment as a DME supplier. Specifically, you’ll need a Type 2 NPI (a unique National Provider Identifier number) to enroll your practice as the billing entity for DME.
Once you have enrolled and received your NPI number, you’ll need a system to file, track, and post payments for Medicare claims properly
To give you the correct guidance and track each claim from creation to payment, you’ll need a biller with extensive experience and Medicare training.
Most Dentists don’t realize they cannot get this kind of experience from someone with only basic dental billing knowledge. That is one advantage of outsourcing with a fully trained remote billing team. You get the guidance you need to file Medicare claims that pay you the highest amounts for appliances for your Medicare patients.
Let a trained remote biller be your guide through Medicare
A growing number of dentists get caught off guard by unexpected denials or violation notices because they are unaware they have treated patients who have Medicare benefits. Patients with Medicare Advantage plans may come to you because Medicare Advantage provides dental benefits.
If you want to treat them, you have to follow Medicare rules, which means you have to understand them.
More people are choosing Medicare Advantage plans as they become eligible for Medicare benefits. Several private insurance companies contract with CMS providers for Medicare beneficiaries. Medicare Advantage plans are available as an option for Medicare-eligible individuals. Some Medicare Advantage contractors include:
Aetna
BCBS
Humana
Cigna
AARP/United Healthcare
If you see any patient with Medicare Advantage benefits, you have a Medicare decision to make. Enrollment in original Medicare is not required to obtain reimbursement from Medicare Advantage plans.
However, if you opt-out of Medicare, you may not be eligible to receive payment from Medicare Advantage plans either.
You have options to manage the Medicare facts every dentist needs to know. Working with trained experts like those at Dental ClaimSupport helps you to avoid costly fines, gain revenue, and reduce the pressure to be an expert yourself on Medicare.
With the help of Medicare expert Glenda Hood, we published the Essential Guide to Medicare for Dentists to help you. And we offer training as well as expert billing services. You deserve the support to make confident decisions about Medicare for your dental practice.
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