b'FOR YOUR PRACTICEAsk the Coding CoachAn area that has caused some concern and confusion over the last several months is reimbursement for Medicare Advantage Plans. The number of these dental plans has increased over the last year and questions raised by both the provider and the patient can be difficult to answer. Most dental offices were encouraged to opt-out of Medicare in the past, and this continues to be the case. But now that many patients have elected to pay for Medicare Advantage plans that include some type of dental coverage, this can result in carriers of these plans denying reimbursement to those who have opted out of Medicare. There are many factors that must be considered when determining if benefits will be available. First, realize that these plans are chosen by individuals, not employers. There are several types of plans, and patients choose plans many times on the cost rather than the actual benefits. Some provide only the basics (e.g., prophylaxes and radiographs), while others may cover some restorative or periodontal procedures. Ideally, the office should look at the specific plan and understand what is covered before treatment is provided. In some cases, a pre-determination should be obtained.If you are not certain if you have opted out in the past, the website to look up CMS opt-out providers is data.cms.gov/tools/provider-opt-Reimbursement is also affected by whether a provider is aout-affidavits-look-up-toolplan participant with a carrier. If they are, reimbursement will be according to the plan contract. If the dentist is fee-for- If you would like to contact CMS to start the process of opting back in, service, however, the fee structure may actually be loweryou can contact ProviderEnrollmentDataRequests@cms.hhs.govthan the contract plan. Benefits will vary not only from planTo summarize:to plan but also from carrier to carrier, so an office should do some research to determine how reimbursement will be1. Determine if you have opted out of Medicareestablished. It is frustrating as well as time consuming for both the patient and the front office staff, but in the long run,2. Establish which Medicare Advantage plans with dentalresearch and pre-treatment estimates will save time andcoverage are the most commonly submitted in your office money as well as avoid frustration on both ends.3. Evaluate fee schedules based on being a plan participant orRemember, too, that many dentists opted out of Medicarefee-for-servicemany years ago, and this opt-out is automatically renewed4. Obtain pre-determinations, if possible unless that dentist requests otherwise. We have had some cases where carriers had reimbursed for treatment submitted and should not have, because the office had opted-out several years ago and are still classified as such. In those cases, the dentist has been requested to refund those incorrect payments. To further confuse the issue, some carriers are now allowing payment to providers who haveSubmit your third-party questions to opted out. There is no general rule for benefitting Medicareinsurance@perio.org. Members with coding Advantage.questions or difficulties with insurance claims can also contact Pam Throw at 312-573-3241 or email pamela@perio.org AAP Periospectives| 27'