New Medicare Regulations to Impact Dentists

The Centers for Medicare and Medicaid Services (CMS) issued a final ruling, which requires healthcare providers, including dentists, who treat Medicare beneficiaries to either enroll in Medicare or opt-out in order to prescribe medication to their qualifying patients with Part D drug plans.

Dentists will need to take action on this requirement by June 1, 2015.

Not many dentists are enrolled in the Medicare program because the plan only covers a limited set of dental procedures.  I don’t see any advantages, at this point, for a dentist to enroll in the program.  The government, however, has a different perspective. 

CMS projects that regulations, such as requiring providers to enroll, will save the federal government an estimated 1.6 billion dollars over the next 10 years.  Based upon perceived cost savings, the government is working to gain a foothold in the door of Dentistry, which will bring about additional regulations and increase the costs of doing business as a Dental professional.

The new regulations offer up a couple of business obstacles to the doctor opting out of the Medicare program:

• A doctor that chooses to opt-out of the Medicare program will be subjected to a 2-year waiting period before they can get back into the program.
• Patients or pharmacies may not receive Medicare reimbursement of the prescriptions that an “opt-out” doctor prescribes. This will be the biggest issue for dentists who decide to opt-out.  Dentists will not see an impact until after they opt-out and patients begin to complain of not being reimbursed for the prescriptions ordered.  Or, the dentist may find pharmacies will not accept their prescriptions because they have opted out.

The American Dental Association has voiced a concern over this legislation, but CMS moved forward anyway.  Even though the implementation of this new regulation will not take place until next year, I think dentists would do well to begin planning for the effects of this legislation.

• Start by looking at the demographics of your practice.  How many of your patients would be affected if you were to opt-out of the Medicare plan?
• If you were to participate with Medicare, how would this impact your billing practices and required compliance programs?
• Begin to investigate this further.  Educate yourself, educate your staff, and educate your patients who may be affected by the choice you make.  Good communication will provide for an easier transition.
• Consider establishing an alliance with physicians and pharmacists in your area that also treat your patients.  Should you opt-out of the Medicare program and find yourself with unhappy patients, having a friendly physician on your side may prove beneficial.

Over the past several years, we have seen government regulations and compliance become a bigger factor in running a healthcare business. In fact, healthcare is fast becoming a very regulated business.  It is second, only, to the financial industry. 

Doctors and other healthcare professionals who wish to run a profitable business will need to make healthcare compliance a regular component of their business.  As your business advisor, we continue to stay attuned to the regulations that affect you and look for ways to help you mind your own business.