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Regional Delta Dental office amends dentists’ contracts to address Medicare

August 15, 2016

By Kelly Soderlund

Delta Dental of Michigan, Ohio and Indiana amended contracts effective Jan. 1, 2017, mandating dentists to take action regarding the Medicare Part D enrollment requirement and complete training in order to participate in Delta's network.

The federal regulations require dentists to take action by either enrolling or opting out of the Medicare program in order for their patients to be eligible for their Part D drug coverage. However, according to Delta Dental of Michigan, Ohio and Indiana, dentists who chose the opt-out option in these states will no longer be eligible to remain Delta network providers. Any dentist who opts out after June 20 will be impacted by this Delta policy.

Those who have opted out before will be allowed to stay in the network but are expected to terminate their opt-out status when the renewal opportunity arises, up to two years later. Note that these dentists cannot be paid for services rendered to Medicare Advantage patients.

Karen Burgess, executive director of the Michigan Dental Association, said the dental society has been receiving a deluge of calls from members since the letter was mailed looking for advice on what they should do.

"This is going to have to be something that each dentist decides for him or herself," Ms. Burgess said. "If you want to continue as a Delta provider, your choices have narrowed. That's a lot of patients and a lot of care that you're not going to be able to provide anymore if you opt out of Medicare."

Any dentist who opts out after June 20  will be impacted by this Delta policy. Those who have opted out will be allowed to stay in the network but are expected to terminate their opt-out status when the renewal opportunity arises, up to two years later. Delta Dental is the largest provider in Michigan.

"Delta Dental is very proud to administer a number of government-sponsored programs and currently serves more than 1 million children and adults whose plans are overseen in whole or in part by the Centers for Medicare and Medicaid Services. These plans include the Healthy Kids Dental program in Michigan and Medicare Advantage. In the coming months, it is expected that enrollment in Medicare Advantage, as well as other government sponsored programs, will continue to grow. Dentists participating in Delta Dental's networks may have patients in their practices who will be transitioning to Medicare Advantage plans in the near future," according to a statement from Delta Dental of Michigan, Ohio and Indiana.  "As part of its administration of those government-sponsored programs, Delta Dental recently issued a routine amendment to its provider agreements in order to ensure ongoing compliance with applicable state and federal laws. These amendments will help to increase access to care for patients who participate in these programs and allow dentists to continue to treat those patients in their current practice who are transitioning to Medicare Advantage plans in the near future."

David Irwin, director of corporate communications for Delta Dental Plans Association, said this is not a national requirement for Delta network dentists. DDPA supports federal bill H.R. 4062, which calls for removing the mandate that Part D prescribing health care providers be enrolled in Medicare in order for their patients' prescriptions to continue to be covered by Medicare Part D plans.

Enrollment can be done either by using the 855i form (for those dentists billing for Medicare Services) or by using the 855o form (for those dentists ordering, referring or prescribing drugs). Opting out may be accomplished by submitting an affidavit to the local Medicare Contractors. Both enrolling using either form or opting out are valid options to allow patients to receive part D drug coverage. However if dentists opt out of Medicare, they cannot receive payment from Medicare Advantage plans (Part C Medicare) that typically cover services like cleanings and X rays.

The contract amendment mailed to all dentists by Delta Dental of Michigan, Ohio and Indiana has a number of other clauses unrelated to the federal regulations, prompting the ADA to encourage dentists to review their third-party payer contracts closely.

"As always it is important for every dentist who participates in a plan to be aware of what they are agreeing to", said Dr. Dave Preble, vice president of the ADA Practice Institute. "The Delta contract amendments apply to all of its network dentists and impose significant record keeping, audit and patient consent clauses."

The ADA has information on contractual clauses available at ADA.org/dentalplans and the Practice Institute also posted a webinar on contracting.