You may be accepting Medicare  at your dental practice without knowing it. In recent years, most Commercial Dental Plans have added a Medicare component to their existing network. This is driving patients with Medicare coverage into otherwise commercial-only practices. The result is that the related federal requirements, as is consistent under all CMS programs, will now be imposed on your practice. These patients are coming into your practice under your commercial contracts thus subject your practice to these related federal requirements.

Participation With Medicare Through Dental Insurance Plans

Cigna Dental is now utilizing a new strategy for putting Medicare patients in to your practice. Cigna is administering a Medicare supplement under the Dental Care Access Plan. The Plan will require the practice to collect the patient copay and bill the plan for the balance. This Medicare supplement administered by Cigna will still need to follow all CMS compliancy requirements.

Participation with federal plans, such as Medicare and Medicaid, is substantially different than participation with commercial plans. We recommend considering three notable differences in network participation before accepting Medicare in your practice:

• Medicare participation has the same regulatory requirements as Medicaid. This includes Fraud, Waste and Abuse (FWA) training annually for all staff, including the dentist.

• Since federal funds are part of the payment that the practice is receiving from the Dental Plans, the processing of claims, resolution of patient issues (complaints) and chart audit requests will become routine and a standard participation requirement.

• The current plans utilize the contracted fee structure, with the majority of payments from the patients. This is different from your existing commercial plan coverages.

Medicare and Medicaid participation requires a more intensive verification of benefits. The practice administration should be adapted when accepting payments with federal funds. It is important to make sure that your practice meets the federal CMS requirements before signing an attestation that legally confirms compliance.

What if I Don’t Want To Accept Medicare In My Dental Practice?

If the dentists at your practice have completed a Federal Medicare Opt-Out, this should be honored by the Dental Plans. The commercial plans should not add the practice to its Medicare component if providers have a Federal Opt-Out in place. We recommend checking patient benefits in advance of care to confirm that Medicare coverages are not involved.

Do you have questions about your commercial contracts, CMS regulatory compliance issues, or about pursuing the Federal Medicare Opt-Out process? Please contact us at 856-235-0020 today.

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At Dynamic Dental Support, we specialize in the business end of dental practices. We offer administrative support and use financial analysis and strategies to assist dental practices in their operations. As a Dental Support Organization (DSO) we provide increased leverage in dealing with the Dental Insurance Plans. For over 25 years, we’ve been developing strategic growth plans for practices like yours.