Rank: Guest
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Our office is currently in the long process of getting Medicare-approved. Our opt-outs have expired but we are not yet a Medicare provider. We have a patient interested in getting an oral appliance from our office. The patient is aware that we are not a Medicare provider at this time and that the appliance we offer (Somnodent Flex) does not meet CMS criteria anyway, but the patient still wishes to see our dentist for this and pay out of pocket. That being said, they still plan to bill Medicare on their own (even though I've explained Medicare wouldn't pay for Somnodent Flex even if we were a Medicare provider).
Could our office face any time of penalty if the patient bills Medicare on their own?
Could Medicare come back and tell us we cannot collect anything from the patient?
...I remember once being told that there was some time of penalty for not being opted in nor out, but I do not recall the specifics and am therefore nervous about this patient getting started.
Thank you.
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Rank: Administration
Joined: 11/21/2012(UTC)
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Hi Guest!
Great questions. If I recall correctly, if you are not yet enrolled or opted out of Medicare, the first time you treat a Medicare patient for services that would be covered, you have 10 days to decide to either enroll or opt out. You're already in the process, so you should be good there!
However, since you are in the process of enrolling as a Medicare DME, I believe this is an appropriate situation to have the patient sign an ABN and you can file the claim on their behalf! Of course if that is the option on the ABN that they choose, that is. (as you said, of course it very likely will not be covered since you are not yet an enrolled DME supplier and the appliance being used is not PDAC cleared for E0486 for Medicare, but you still file the claim anyway!). This way, if you have the signed ABN, you can collect from the patient.
And no, a patient can file their own claim to Medicare on a form called 1490s if needed,
Hope this helps!
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