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MyView: Medicare signup: more than just drug coverage

March 07, 2016

By Craig B. Fowler, D.D.S.


Dr. Fowler
The decision of whether or not to enroll in Medicare affects more than just drug coverage.

Did you know that if you send biopsies to an oral pathology laboratory on a Medicare-eligible patient, refer a Medicare patient to an imaging center for diagnostic studies such as a cone beam CT or MRI, or order durable medical equipment such as a sleep apnea device for a Medicare patient, you must register with the Centers for Medicare & Medicaid Services or formally opt out of Medicare in order for the oral pathologist, oral radiologist or durable medical equipment supplier to get paid for his/her services.  

The easiest way to comply is to register with CMS as an ordering and referring provider using Form 855O. It is a much shorter and easier form to complete and doing so will also allow your Medicare patients to get any drugs you have prescribed that are covered under Medicare Part D or a Medicare Advantage plan.

Under current law, Medicare will not pay for these drugs if you fail to register by June 1. This will also allow you to submit claims to Medicare Advantage plans, some of which do cover dental services.  

If you formally opt out of Medicare, oral pathology services, imaging centers and durable medical equipment suppliers will still receive payment for their services from Medicare, and patients still can get their Part D covered drugs paid for by Medicare.

However, to opt out legally, dentists must fill out an affidavit that must be sent to all applicable Medicare contractors and enter into private contracts with Medicare patients before providing items or services covered by Medicare. In addition, dentists who opt out will not be able to submit claims for dental services to Medicare Advantage plans and neither will their Medicare patients.  

Remember, opting out of Medicare is not the same as doing nothing. A decision tree, frequently asked questions, and a tutorial video can be found at Success.ADA.org/en/practice/medicare. For more information on the consequences of not taking action, click here.

Dr. Fowler is the president of the American Academy of Oral & Maxillofacial Pathology and an associate professor in the Division of Oral and Maxillofacial Pathology in the Department of Oral Health Science at the University of Kentucky College of Dentistry.