A: You will not know exactly what is going to be covered by Medicare beforehand. However, the Medicare Fee Schedule is posted for every region which allows each of our members to predictability be within a few hundred dollars on any estimate you provide.
Additionally, once your team is fully onboarded with our preferred billing company, there is an estimator tool that will further refine your estimate.
Past the estimated benefit, you will charge and collect from the patient all of the dental-related treatment fees such as restorations which are 100% outside of the Medicare system and are not affected by your participation with Medicare.
You will make financial arrangements on the balance of your total treatment plan fee, just as you would with any fee-for-service patient.
The power for working to obtain benefits for patients via their Medicare coverage is that the patient has a reduced out-of-pocket cost (25-50% less cost to the patient), while you are getting at least 100% of your total case fee.
For the practice this reduces the discounting pressure often resulting from local competitors seeking to treat these same patients. Your competitors who cannot bill Medicare are unable to discount their total case fees by 25-50% to compete with the final cost a patient pays out of pocket to your practice!
You will also know whether the patient has coverage for services. With our training and assistance, you will never start treatment without knowing that some coverage exists. Our experienced biller/coder will guide you throughout and make inquiries and appeals when needed.