ADA urges dentist exemption from Medicare enrollment

Washington—The Association urged federal health officials to exclude dentists from proposed regulations that would deny claims for Medicare Part D drugs unless the prescriber is enrolled in Medicare or has a valid opt-out affidavit on file.

The administration withdrew the broad-based proposal in the face of professional and congressional opposition but signaled intent to revisit and “finalize” regulations “strengthening standards for prescribers of prescription drugs.”

The new enrollment requirement if implemented “will affect the majority of dental practices,” the Association told federal health officials in the March 5 letter. The Affordable Care Act authorizes but does not require the Secretary of Health and Human Services to extend the enrollment requirement to prescribers of Medicare Part D drugs.

“The ADA requests that the [HHS] Secretary exclude dentists from this proposed requirement as it places an unnecessary burden on dentists and their Medicare eligible patients that will not serve to address the underlying rationale for [ACA] Section 6405, which is to stop fraud and abuse in the Medicare program,” the letter said.

“The Association applauds the Department of Health and Human Services and Department of Justice’s efforts to prevent fraud, waste and abuse in Medicare,” the Association said.

“As taxpayers, dentists are also concerned about criminals masquerading as health care professionals or suppliers, submitting false or fraudulent billings to Medicare.

“However, the ADA is not aware of any high-billing levels associated with prescriptions written by dentists for Medicare eligible patients.

“While there appears to be little need for this requirement as it applies to dentists, the administrative burden would be significant.”

While most physicians who prescribe covered drugs for Medicare Part D enrollees may be enrolled in an approved status in Medicare, many dentists are not currently enrolled as either a Medicare provider or as an ordering or referring provider or have not opted out with a valid affidavit on file with a Part A/Part B Medicare administrative contractor, the Association said.

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