Important Medicare Information for 2015
Dental practices who wish to bill Medicare for oral appliances for Obstructive Sleep Apnea must enroll their locations as DME supplier (either participating or non-participating). BUT - there are new rules this year for enrollment for dentists for Medicare Part B who order and/or refer for things like prescription drugs and lab tests! The information we have provided below can help you determine what you should do - if anything, for your practice.
If all you are interested in is billing Medicare for oral appliance for Obstructive Sleep Apnea, you will enroll your location as a DME supplier with Medicare using the 855s enrollment form.
What are your enrollment options for Medicare Part B?
1. Opt-out of Medicare Part B - the opt-out period is currently 2 years. Prescriptions and ordered tests will be reimbursed for opt-out providers. Note: According to Medicare, dentists who are DME suppliers are not eligible to opt out.
2. Ordering and Referring Provider Only - If you do not provide Medicare Part B covered services, enroll as an ordering or referring provider to ensure that Medicare will reimburse for ordered items such as prescriptions under Medicare Part D or x-rays starting in 2016.
3. Enroll as a participating or nonparticipating Medicare Part B provider - and bill Medicare Part B for the rare covered services. Nonparticipating providers are allowed to charge 115% above Medicare’s set fees as a limiting charge for covered services.
4. Do nothing - If you do not write order or refer for Medicare beneficiaries or provide covered services taking no action is also an option.
Medicare Enrollment Requirements for Ordering/Referring Providers
Medicare has announced a delay to the enrollment requirements for providers who prescribe Part D drugs to their Medicare patients. The new enrollment deadline is January 1, 2016.
The original deadline for providers to submit their enrollment forms (855i, 855o, or opt out affidavits) was June 1st, 2015. A week after the original deadline, Medicare update their website with the following language:
"Any physician or other eligible professional who prescribes Part D drugs must either enroll in the Medicare program or opt out in order to prescribe drugs to their patients with Part D prescription drug benefit plans. Medicare Part D may no longer cover drugs that are prescribed by physicians or other eligible professionals who are neither validly enrolled, nor opted out of Medicare. All prescribers should enroll before January 1, 2016 to allow for the processing of applications and to ensure enrollees get their prescriptions."
Here is a link to the Part D prescriber information for Medicare:
http://www.cms.gov/Medicare/Provider-Enrollment-and-Certification/MedicareProviderSupEnroll/Prescriber-Enrollment-Information.html
What should you do?
First, check your enrollment status with Medicare, which can be done online using PECOS
https://pecos.cms.hhs.gov/pecos/login.do. Nierman Practice Management acquires Medicare’s updated enrollment data for approved ordering/referring providers weekly and will be happy to check for your credentials on the list to help you get started in making your decision.
2. ICD-10 Medical Billing Changes - Top 5 Things You Need to Know
- HIPPA mandates that all health insurance companies make the transition to ICD-10.
- ICD-10 will replace the United States current ICD-9 system for every assigned medical diagnosis and description of symptoms for patients.
- The United States is the only remaining country to utilize the 30-year-old set of ICD-9 codes.
- The new ICD-10 code change will allow a more expansive, accurate system to better track data, process claims for reimbursement, and improve administrative performance.
- ICD-10 has more than 141,000 codes. That's 8 times the 17,000 codes in ICD-9 .
Nierman Practice Management
Nierman Practice Management is the industry leader in helping dental practices grow through sleep apnea treatment, TMD, and medical billing/cross-coding implementation. We uphold the responsibility of staying on the forefront of industry changes to inform and equip our clients with the information they need to stay ahead of the game.
Our Latest Solutions:
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Get Paid: CrossCode™ Medical Billing Services for Sleep Apnea, TMJ, Implants, & More
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1-800-879-6468 to speak to an expert about one of our solutions, or
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Best Regards,
The Nierman Team