What to Expect During Medicare Enrollment Process
Commonly, most dentists have decided to enroll in Medicare to provide covered services to Medicare beneficiaries or recipients. However, some dental practitioners will have to enroll in the Medicare program for the only purpose of certifying or ordering services for Medicare beneficiaries. These physicians usually do not send claims to a Medicare Administered Center for the services they render. In this article you’ll learn more about dentists’ Medicare enrollment and what to expect in this article.
Some dentists are interested in enrolling in Medicare because of patient demographics or service to their patients. At the same time, some practices choose to become durable medical equipment suppliers. A rule put out by CMS that states “requires any physician or eligible professional that writes prescriptions for drugs covered under Medicare Part D to either enroll in or opt-out of Medicare.” Dentists’ Medicare enrollment can be easy, yet a very particular and thorough process.
The first half of this article encompasses an overview of what you can expect throughout the entire Dentists Medicare enrollment process.
Providers can submit CGS applications via standard or expedited mail or electronically through Pecos Web (faxed or emailed applications are no longer accepted). Within ten days of receipt, providers can expect to receive a letter acknowledging receipt of the application.
< 20 days after receipt, applications are reviewed for missing or clarifying information. If additional information is needed, providers can expect to receive a letter requesting additional information. Providers have 30 days to submit additional information, or the application will be rejected and closed. If no additional information is needed, no request letter is sent; the application continues processing.
In less than 30 days of receipt of a complete application and/ or additional information, providers can expect the enrollment to be updated. Site visits address validation, and CMS requirements can cause delays during this stage. Promptly responding to a contractor’s request will ensure your application is completed faster.
The application is resolved, and a final letter is issued. Click the applicable link to see the average processing times for your application type.
- Part A: https://www. cgsmedicare.com/medicare_ dynamic/cyctime/j15a.asp
- Part B: https://www. cgsmedicare.com/medicare_ dynamic/cyctime/j15b.asp
- HHH: https://www. cgsmedicare.com/medicare_ dynamic/cyctime/j15hhh.asp
This Job Aid consists of providers’ and contractor’s actions and general time-frames. You can visit What to Expect When ENROLLING for the full details. It includes information and a guide to CMS Paper or Web application, with or without corrections.
The second part of this article is to answer your Dentists’ Medicare enrollment-related queries.
DO I NEED TO EITHER ENROLL IN MEDICARE OR FORMALLY OPT OUT?
If you provide Medicare-covered items and services you need to either enroll using form CMS-855I or formally opt-out.
If you don’t provide Medicare-covered items and services, but you order covered clinical laboratory services, imaging services, or DMEPOS for patients on Medicare, you need to either enroll or formally opt-out. You can enroll using a shorter enrollment form called CMS-855-O.
I PROVIDE MEDICARE COVERED ITEMS AND SERVICES. HOW DO I ENROLL IN MEDICARE?
According to the Center for Medicare and Medicaid Services (“CMS”), “Physicians, non-physician practitioners, and other Part B suppliers must enroll in the Medicare Program to get paid for the covered services they furnish to Medicare beneficiaries. Enrolling in Medicare authorizes you to bill and receive payment for the covered services you furnish to Medicare beneficiaries.” The Medicare definition of “physician” includes dentists.
For information about enrolling in Medicare, visit CMS, Medicare Provider-Supplier Enrollment.
Enrollment information is also available in Fact Sheets from the Medicare Learning Network entitled The Basics of Internet-based Provider Enrollment, Chain and Ownership System (PECOS) for Provider and Supplier Organizations (PDF), Internet-based PECOS FAQs (PDF), and The Basics of Medicare Enrollment for Physicians and Other Part B Suppliers (PDF).
NOT SURE WHETHER TO OPT IN OR OPT OUT?
This handy flow chart prepared by the ADA will walk you through the decision making process.
HOW LONG DOES AN OPT-OUT LAST?
Once you file an affidavit notifying the MAC that you have opted out of Medicare, you are out of Medicare for two years from the date the affidavit is signed, unless you terminate the opt-out early under §40.35 of the Medicare Benefit Policy Manual (PDF), or unless you fail to maintain opt-out (see §40.11 of the Medicare Benefit Policy Manual [PDF]). After those two years are over, you could elect to return to Medicare or opt-out again.
The dental industry is still reeling in the midst of the pandemic and the throes of a national struggle for our lives and our democracy. Leaders and CEOs have found themselves at a historic crossroads, managing short-term pressures against medium- and long-term uncertainties. Our dental frontline workers have faced the unprecedented stress of caring for patients in risky and sometimes untenable working conditions, as COVID-19 continues to reveal inadequacies, inconsistencies, and inequities in our systems.
During the global pandemic, the dental delivery value chain is undergoing five key shifts that will lead to the vast potential across infrastructure, providers’ geographic distribution, and care settings: Learn more about the five key shifts here COVID-19: The unintentional accelerator for dental industry transformation.
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