I n s ura n ce Con nect ion
ADA Delivers Good News for Dentists Who Opted Out of Medicare
ADA is aware that some insurance carriers are now enforcing the
Medicare “Opt-Out” status for which some of you applied when
the ruling became effective years ago. Many of you are now
being told that you will not receive reimbursement from
Medicare Advantage plans. A list of practitioners that CMS has
a record of having opted out is available here: https://data.cms.
gov/Medicare-Enrollment/Opt-Out-Affidavits/7yuw-754z
CMS proposed rules in 2015 that pertained to Part D (drugs)
& Part C (i.e. Medicare Advantage plans) of Medicare. The
Medicare Part D proposal required dentists to either enroll or opt
out so that benefits would apply to prescriptions. The Part C
rule required dentists to enroll in order for the MA plans to be
able to pay claims for supplemental dental services covered
under the MA plan. This was communicated by ADA: https://
www.ada.org/en/publications/ada-news/2015-archive/june/
medicare-enrollment-delayed and https://success.ada.org/
en/regulatory-legal/medicare/frequently-asked-questions
Subsequent to these rules being published ADA lobbied
very hard to rescind the rules requiring action by dentists, and
WON! On April 16, 2018, CMS published a final rule that
rescinded the proposals. https://www.ada.org/en/
publications/ada-news/2018-archive/may/cms-finalizes-
rule-rescinding-parts-c-d-enrollment-requirements
However, as noted in the above referenced ADA News story,
dentists who did not wait for the final rule to be published and
took action in the interim by specifically opting out of Medicare
in response to the Part D rule, unfortunately were caught in the
middle and will not receive payment from MA plans. The good
news is that this status is not permanent. Opt-out affidavits
signed on or after June 16, 2015, will automatically renew every
two years. If a dentist who filed a valid affidavit effective on or
after June 16, 2015, does not want the opt-out to automatically
renew at the end of a two-year opt-out period, the dentist
may cancel the renewal by notifying all Medicare
Administrative Contractors (MACs) with which the dentist
filed an affidavit in writing at least 30 days prior to the start of
the next opt-out period. Valid opt-out affidavits signed before
June 16, 2015 will expire two years after the effective date of
the opt-out. In addition, a dentist who opts out of Medicare for
the first time may terminate the opt-out by notifying all MACs
with which the dentist filed an opt-out affidavit within 90 days
of filing the original opt out affidavit.
(Information provided courtesy of the ADA)
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