Medicare Enrollment Forms

(The following information contained is copyrighted and taken verbatim from the 2017 “Z Book”, aka “Accessing Medical Benefits in the Comprehensive Dental and Surgical Practice”)

STEP 1: DETERMINE WHETHER BECOMING A MEDICARE PROVIDER IS WORTH IT TO YOUR PRACTICE

Do you have Medicare-insured patients who require these procedures?

1. REMOVAL OF PATHOLOGY, BOTH SOFT AND HARD TISSUE

This includes pathology as it relates to lesions, but excludes pathology that is tooth-related, ie. Abscesses, cysts, etc.

2. TREATMENT RELATED TO CANCER OR TUMOR REMOVAL

Patients that have had any type of treatment that resulted in damage to the oral structures, be it chemotherapy, radiation, or surgery, typically are covered for repairing of the damage.

3. TREATMENT RELATED TO TRAUMA

Patients that have sustained traumatic injury to their jaw/teeth will be covered for extraction of those teeth as part of the repair of the fractured jaw. Reduction of the fracture, as well as wiring of the jaws/teeth is also covered.

4. TREATMENT OF SLEEP APNEA

Sleep studies and appliance therapies, as well as surgical correction for airway obstruction.

STEP 2: DETERMINE WHICH PROVIDER STATUS YOU WISH TO APPLY FOR

What is the difference between the different provider statuses? Here is an explanation, taken from the 2017 “Z Book”, aka “Accessing Medical Benefits in the Comprehensive Dental and Surgical Practice”^©

i. PARTICIPATING (PAR) PROVIDERS

· agree to accept Medicare allowable fees for procedures billed to Medicare

· are paid directly by Medicare for covered procedures

· are paid automatically and directly by the supplement (if the patient has supplemental coverage), without having to submit another claim for any deductible and co-payment

· CANNOT balance bill patient over and above the Medicare allowable fee

· If you also wish to bill Medicare for sleep apnea appliances, a SEPARATE DMEPOS number is required

ii. NON-PARTICIPATING (non-PAR) PROVIDERS

· agree to accept Medicare Non-Participating Provider fees for procedures billed to Medicare (Non-PAR Allowable benefit is 95% of the PAR Allowable benefit)

· have the option of either Accepting Assignment or Not Accepting Assignment on a claim by claim basis

· are paid directly by Medicare for covered procedures, when they Accept Assignment

IF THE non-PAR PROVIDER DOES NOT ACCEPT ASSIGNMENT, then payment in the amount of 80% of the Medicare non-PAR benefit will go to the Patient, and the Provider can then collect ONLY UP TO THE MEDICARE LIMITING CHARGE.

iii. "ORDERING AND REFERRING" PROVIDERS

· cannot send claims for their services to Medicare for reimbursement

· will be placed on the Medicare Ordering and Referring Registry

· will be able to order prescriptions, laboratory services, and refer patients to Medicare-enrolled providers and suppliers

Patients will not pay out of pocket for services provided by these Medicare providers, including pharmacies.

iv. DMEPOS PROVIDERS

· can only bill for covered appliance, i.e. sleep apnea appliances

· must obtain a separate DMEPOS number (DMEPOS=Durable medical equipment. prosthetics, orthotics, and supplies)

STEP 3: CHECK OUT THE APPLICATIONS ON THE MEDICARE WEB SITE

IMPORTANT: Whether you want to enroll as a Participating, Non-Participating,  Ordering and Referring, and/or a DMEPOS Provider, the process requires completing a lengthy and complicated application, followed by multiple calls to Medicare to check the status, A DELAY OF ABOUT 3-4 MONTHS, during which Medicare claims cannot be filed, nor will patients be able to have their prescriptions or treatment by Medicare dentists/doctors, to whom you have provided a referral, paid by Medicare.

The Z Group can not only complete the application(s) for you, but also expedite the process. We have tested our processes and can confidently say that we are able to get the application processed and have your PTAN and/or DME number issued within 30 business days.

Please complete the contact form if you are interested in this service:

http://thezgroupllc.com/form.html