ADA on Medicare Part D opt-out, Medicaid


Special Note: The MDA continues to discuss this issue, and its implications for members, with the ADA. We want to stress it is up to each individual provider to determine a decision on opting “in” or “out” of Medicare. However, we would caution providers that there is time to make a decision. With the many issues and concerns being brought forth by the ADA and other dental professional organizations to CMS on this matter, it may be best at this time to stay tuned for further details before taking action. Continue to keep up to date and become familiarized by reading the excellent details on the ADA website (referenced in this article). The ADA site provides members with the details necessary to make considerations. We caution that using an outside consultant will result in costs, and at this time should not be necessary. Stay tuned for information on a webinar that will address more specifics on this and give members a chance to have questions answered more thoroughly.


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n a January 16 ADA Leadership Update, ADA Executive Director Dr. Kathleen O’Loughlin reported that she and ADA Washing- ton D.C. office staff recently met with Centers for Medicare and


Medicaid Services (CMS) Administrator Marilyn Tavenner to discuss issues important to the dental community, including the Medicare Part D opt-out provision, Medicaid reform and RAC audits.


The issues discussed included the final rule published early last year that requires dentists who prescribe Part D covered drugs to be en- rolled in Medicare or to opt out.


The ADA is concerned about the rule because it would deny payment for a Medicare beneficiary’s medication if the prescribing provider had not either enrolled or opted out of the program. The ADA has actively opposed this provision as it applies to dentists and currently is seek- ing an exemption for the dental profession. After the ADA asked for a delay of enforcement, CMS pushed back the date; although the enrollment deadline remains June 1, 2015, the agency will not enforce the rule until December 1.


During this meeting Ms. Tavenner acknowledged that the approach CMS has taken on keeping Medicaid programs from making improper payments may not be universally applicable to both medicine and dentistry, which is the point that the ADA has repeatedly made. Ms. Tavenner promised that she and her staff would work with the ADA to move the process forward.


The ADA also discussed its ADA’s Medicaid reform initiative and explained it’s objectives to increase both the number of Medicaid ben- eficiaries receiving dental visits and the number of dentists partici- pating in state Medicaid programs. The ADA expressed its desire to continue working with CMS and state governments to help improve dental Medicaid, citing its Action for Dental Health (ADH) initiative, which has identified 10 states in which the dental associations are ad- dressing barriers to participation.


Finally, the ADA raised the issue of RAC (Recover Audit Contractor) audits, a significant concern for ADA members. They explained that dentists would like additional guidance on how to avoid triggering the audits, which are intended to recover improper payments. Ms. Tavenner stated she was open to continued discussions on this issue as well; the ADA will be following up with a member of her staff.


It is critical for the ADA and CMS to work together, especially as the Association moves forward with its ADH Medicaid initiative. For its part, CMS is seeing good results with its Oral Health Initiative, de-


22 focus | JAN/FEB 2015 | ISSUE 1


signed to ensure that children enrolled in Medicaid get good quality dental care. As Ms. Tavenner acknowledged, collaboration with the dental community is a big part of the reason for that success.


MEDICARE RESOURCES AVAILABLE AT SUCCESS.ADA.ORG


While this discussion continues, the ADA Center for Professional Suc- cess, has a great deal of information to help dentists learn about, and decide, whether to enroll or out-opt of Medicare, available at http:// success.ada.org. A few of the most commonly asked questions regard- ing enrolling and opting out of Medicare covered on the site include:


 What does enrolling in Medicare mean and what does opt-out mean?  Why am I being asked to enroll in Medicare? Medicare doesn’t cover dental treatment or at least the dental treatment I provide my patients.


 I want to enroll as a Medicare provider. What exactly do I need to do?


 I want to enroll as an ordering and referring Medicare Provider. What exactly do I need to do?


 When I tried to enroll in using either the 855i or the 855o, I did not see my specialty listed. What should I do?


 I want to opt out. What exactly do I need to do?


Additionally, a dentist must follow certain steps to formally opt out of Medicare. If you are considering this, you should read the site information before making your decision. The ADA provides a sample affidavit that you can use to opt-out of the program and a private contract that you can use if you choose to provide Medicare covered services to your Medicare-eligible patients after you have opted out. f


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