Medicare Enrollment for Dentists (Will my Enrollment Gets Deactivated?)

See also: How To Know If A Medicare Provider in California Accepts Medicare Patients?

It is inevitable that after months or years after the enrollment, there are instances when some dentists would remain active in servicing their Medicare patients. While on the other hand, due to circumstances, some dentists would become unproductive.

This article will provide you information on Medicare enrollment for dentists. And answer questions, such as “Does the enrollment get deactivated if the practice has not billed Medicare in more than a year?” Read on to find out the answer to that, and more.

If the process of approving the enrollment would require investigation like a site visit, then that same process also applies to deactivation. The people handling the enrollment application will analyze to filter out the healthcare providers enrolled in Medicare to order covered clinical laboratory services, imaging services, etcetera, and to those who are mass immunizers. The providers enrolled in this category are excluded from the rule of deactivation. But any provider who will get deactivated will receive a notification Medicare Administrative Contractor.

Medicare Enrollment for Dentists: Is Opting Out Also an Option?

As a dental patient, do you understand what it means when your dentist has opted out from Medicare? It means that your dentist does not accept Medicare and has signed an agreement to exclude them from the program. Why do you think that some dental healthcare providers decide to opt-out?

They like opting out, basically because they have the freedom to set their rules and fees, which allows them to ignore Medicare billing rules. Despite opting out, they can still assist Medicare patients but must enter into private contracts with them.

Do Providers Need To Enroll Even If They Don’t Provide Medicare Part B Covered Services?

Not all dental healthcare professionals enrolled in Medicare provide Part B covered services. Some of these professionals are enrolled in Medicare to become qualified in order cover clinical laboratory services, imaging services, and DMEPOS. 

To enroll in this category, dentists should choose CMS-855O for Ordering and Certifying Physicians and Non-Physician Practitioners. They can download the PDF file, have it printed and leave a signature before sending it via mail. Furthermore, if they’d like it paperless, they can also have the enrollment through PECOS.

Despite being tagged as “enrolled,” they are not allowed to submit claims to Medicare. Not unless if they wanted to covert their application to CMS-855I so they can get reimbursed. You can check out the PDF file to learn about the conversion process.

What Are The Medicare Part B Covered Services?

See also: What To Know About Medical Billing Services For Dentists
  • Medically necessary services/supplies.  As per the Medicare glossary, when it says “medically necessary”, it means that these are “health care services or supplies needed to diagnose or treat an illness, injury, condition, disease, or its symptoms and that meet accepted standards of medicine.” So if a service rendered by a dentist is for dental care and not used to treat the patient’s medical condition, the patient might pay for it out of pocket.
  • Preventative services:  These are services that would include the following: test screenings, medical check-ups, and patient counseling to prevent illnesses, disease, or other health problems.

To sum everything up, not all dental providers are enrolled in Medicare and accept assignments. As a dental patient, it is best to check and coordinate with your dental health provider about the charges, or you might end up paying the out-of-pocket amount.

All dental providers have their reasons not to enroll or to opt-out, but whatever their reasons are, dental patients should also investigate and know their dentist as well as what their practice offers.

There are a lot of crooked people these days, so be careful. It is the patient’s responsibility to be vigilant to avoid excess charges. You can also¬†call OneMedAll to learn and find the best dentist for you.¬†

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