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Dentists who already opted out remain so for two years

December 05, 2017

By Jennifer Garvin

Baltimore — Thanks in part to significant advocacy efforts from the ADA, the Centers for Medicare and Medicaid Services announced Nov. 16 plans to rescind certain Medicare Part D and C requirements for providers.

This means that dentists no longer need to enroll or opt out of Medicare to continue to provide dental care and prescriptions for Medicare Advantage and Part D drug plan beneficiaries. However, the agency has not rescinded the two-year opt-out period for providers, meaning dentists who acted in good faith and chose to opt out of the program are still prohibited from accepting payments for services covered by Medicare Part B or Medicare Advantage plans. It also means that their patients' claims will also be denied.

According to the CMS website, the opt-out period remains two years and "cannot be terminated early unless the physician or practitioner is opting out for the very first time and the affidavit is terminated no later than 90 days after the effective date of the physician or practitioner's first opt out period."

For opt-out affidavits signed on or after June 16, 2015, CMS says the opt out will "automatically renew every two years." The agency says that dentists who file a valid opt-out affidavit after June 16, 2015, and do not want to extend their opt-out status at the end of the two-year period, may cancel by notifying in writing all Medicare contractors with which they filed an affidavit at least 30 days prior to the start of the next two-year opt-out period.

The ADA realized this conflict as early as 2015 and has asked CMS to instruct Medicare contractors to allow dentists who have opted out to terminate the opt out and enroll as either an ordering and referring or as a Medicare provider, but the agency has declined to change the length of the opt-out period.

For more information, including a listing of all physicians and practitioners that are currently opted out of Medicare, visit CMS.gov.