OSOMS President's Update: December 2016
Dear OSOMS Members:
As we reflect on 2016, we have to appreciate our 2016 accomplishments and plan for 2017. We have worked through many minor issues to keep our specialty on track, but our major challenge has been the Ohio Board of Pharmacy. The OSOMS Executive Council, especially with the help of Greg Ness, has worked with the ODA to reign in the Pharmacy Board. We do not need a TDDD to reconstitute medications and most of us can continue practicing as we have without another regulatory body inspecting us. We still have the Ohio State Dental Board as our regulatory agency and we have not added the Pharmacy Board to that list. However, we will have to watch SB 319 which our Ohio Senators want to pass. SB 319 would force us to obtain a TDDD to function as an OMFS.
As you pay your dues and contribute to PAC’s at the end of the year, please be reassured that OSOMS and AAOMS, along the ODA, are working to help us maintain our successful practices in Ohio. I have been impressed with our Executive Council members and their dedication to preserving our specialty. Please realize that our PAC’s are important to keep us successful.
At our last Executive Council meeting on October 21, 2016, I reviewed my desire to have OSOMS more involved in practice management decisions. The Council agreed. Presently, we have decisions to make regarding Medicare. I researched them and want to remind you of these changes. Since I am a solo practitioner, I have always paid attention to reimbursement issues. Please be sure that your office manager understands these changes.
Medicare Part D is becoming a new insurance opportunity for dental and medical insurance companies. Supplemental plans are bundling products and these products can affect us. As dental insurance carriers enter into Medicare Advantage programs, your status with Medicare will affect your ability to be paid by a dental carrier for Medicare Advantage programs and eventually impact your ability to be a participating provider with dental and medical insurance providers. The private insurance companies are forced to have a CMS compliant network. Your Medicare status affects your ability to be compensated by private insurance carriers.
What should you do? First, if you enroll or are a Medicare provider, you are fine, but you must comply with Medicare guidelines. Second option: you can enroll in Medicare as a referring/prescribing provider and be eligible for prescriptions you write or referrals for studies to be covered. Third option: If you take no action regarding Medicare, you can be paid by the dental carrier, but any prescriptions or referrals are not covered (the pathology labs will not be paid, so your patients will receive a bill from an outside entity). Fourth option: If you opt out of Medicare, your dental and other carriers will not be able to reimburse you for services to a Medicare Advantage plan member, but prescription and referrals will be paid. Soon, the insurance carriers will force you out of network because they must be CMS compliant and the government will force them to insure compliance for all network providers. Despite the potential changes in healthcare with a new president, the insurance providers made amendments to contracts and these amendments go into effect on January 1, 2017.
There will always be changes and we must adapt. That is why I feel it is important to stay engaged in the OSOMS, AAOMS, and ODA. As you negotiate all of your year-end decisions, please take time to appreciate the Holiday Season.
Robert J. Dornauer, MS, DDS
OSOMS President 2016-2017