Medicare and the Dental Office

There….I said it….can you say it out loud?

We are all aware of the looming changes to the dental community that will become effective in 2016 regarding Medicare and the dental office. Even though most services provided in the dental office will not be covered, there are some services that may potentially be eligible for coverage.

Do you take or read CT scans? Perform biopsies? Provide TMJ services? Perform oral surgery? Have you ever seen a patient due to an accident? Provide Dental Sleep Medicine services (Oral appliances for treatment of obstructive sleep apnea)? Welcome to the world of medical insurance in the dental office, specifically Medicare!

Let’s take a look at dental sleep medicine services and treating with oral appliance therapy:

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In over 15 years of working in dental sleep medicine offices and consulting dental offices on OSA coverage and following medical insurance guidelines, the Strict CMS replacement guidelines have always been cumbersome for both the provider and the patient. Reimbursement from Medicare is allowed to replace an appliance every 5 years TO THE DAY-even though in many instances the device may not last 5 years! There are a few exceptions allowed however more often than not, it is an out-of-pocket expense for the patient.

Why is 5 years to the day for replacement so problematic?

This is a multiple layered question, for a patient that uses their appliance every night for 6-8 hours, 5 years is a long time for the appliance to keep its integrity. Some patients  brux or clench their teeth. All night long, that’s 14,600 hours of abuse on a piece of metal and acrylic!

Patients may have changes in their dentition due to loss of a tooth or other reasons, causing the device to fail and lead to repair or replacement prior to the 5 year mark. More common problems encountered are dropping the device, leaving it for a pet to chew or play with or even stepping on it. The scenario’s can go on and on.

What can you do to help your patients find peace of mind even after their lab warranty has expired, when they know the appliance has to last 5 years or they will be paying out-of-pocket for the repair or replacement? Why not offer them a protection plan through Dental Warranty to protect their device against any mishaps. This can apply to all patients regardless if they are covered under Medicare, a private insurance or even the self-pay patients!

Have you considered giving the “gift” of a Dental Warranty to the patient? What a great PR tool! Everyone loves something for “free”. They may even tell their friends!

About Jan Palmer

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Jan Palmer , FAADOM provides consulting services for dental sleep medicine offices on administrative aspects of treating obstructive sleep apnea in the dental office. She brings information on medical coding and billing, teaching teams to understand requirements on maintaining medical records and how to follow the mandated policies set forth by Medicare. Ms. Palmer works with offices all over the country while maintaining a practice administrator position in a busy New England office.

Ms. Palmer has been a speaker for the American Academy of Dental Sleep Medicine for several consecutive years along with being a facilitator in their virtual study club, has been published in The Dialogue Magazine on medical insurance and the dental office and has co-written a Dental Codeology e-book titled Medicare: What Every Dentist Needs To Know About Medicare NOW! She is a proud Fellow of the American Academy of Dental Office Managers.  Ms. Palmer is a member of the Medicare NHIC DME MAC Outreach and Education Advisory Group, 2015.

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