Billing Medicare For Dentistry & The Types of Providers

Medicare Care For Dentistry

Billing Medicare for dentistry can seem overwhelming. However, in order to help you here is some guidance that might help you make your decision and show you the potential of it in your practice. So which type is right for you?

Participating Provider

When billing Medicare for dentistry as a participating provider you do accept Medicare and you always take the assignment of benefits. This means you agree to the Medicare-approved amount for health care services as full payment. This does not include the deductible or co-pay. Medicare will process the claim and pay you directly for covered services. The patient is responsible for paying the 20% co-insurance for all Medicare-covered services.

ABN (Advanced Beneficiary Notification)

If the procedure/service is not covered by Medicare, it is important that you get a signed ABN (Advanced Beneficiary Notification) form. You can download instructions on how to fill out an ABN form on the Centers For Medicare and Medicaid website. This form confirms that the patient understands the procedure is not covered by their medicare. If, based on Medicare coverage rules, you have reason to believe that Medicare will not pay for the service. The ABN form must follow the below criteria.

    • The ABN form cant be:
      • Difficult to read or hard to understand
      • Given by the provider to every patient with no specific reason as to why a claim may be denied
      • Missing a list of the actual service(s) provided
      • Signed after the date the service was provided
      • Given to the patient during an emergency or given just prior to the patient receiving a service (for instance, immediately before a procedure)

Non-Participating Provider

When billing Medicare for dentistry as a non-participating provider, you do accept Medicare. However, you do not agree to always accept assignment of benefits. Meaning that as the provider you do not accept the Medicare fee as full payment of service. Because of this non-participating providers can utilize a limiting charge. Which allows you to bill up to 15% more than Medicare’s approved amount. As a result, the patient is responsible for 35 percent (20 percent co-insurance + 15 percent limiting charge) of Medicare’s approved amount for covered services.

Be sure to check your local medicare laws. Some states may restrict the limiting charge when patients see non-participating providers. For example, New York State’s limiting charge is set at 5% instead of the regular 15% for most services. So as a safe rule of thumb, contact your State Health Insurance Assistance Program for more state-specific information.

*The Limiting charge rule does not apply to DME (durable medical equipment).

Opt-out Providers

As an opt-out provider, you do not accept Medicare at all. As a result, you have a signed agreement that excludes you from the Medicare program.  This means you can charge whatever you see fit for services rendered. With that said you still need to follow several rules. Medicare does not pay for care except in emergencies but services will be limited. The patients are entirely responsible for any procedure or service. You must provide your patient with a private contract giving a detailed breakdown of their charges. The contract confirms that the patient is responsible for the entire procedure cost. Because Medicare will not reimburse the practice or the patient.

*Opt-out providers do not bill Medicare for services.

Is Billing Medicare for Dentistry Right For You?

Billing Medicare for dentistry can be a great tool for your practice. It also is a benefit that you can pass onto your Medicare patients. The type of medicare provider you want to be is open to what fit is best for your office. If you have any further questions you can contact us.

Imagn Medical Billing Service

Due to the complex nature of medical insurance billing, most dental offices are not equipped with the knowledge to properly credential national payers, submit successful claims, or handle aging and appeals. Imagn Medical Billing Service performs the proper credentialing and billing for you, which results in fewer denials and time well saved as you rely on expert help.

One-Time Credential Fee

$795/per dentist

The key to more successful payments

Our experts complete the process so you can start billing medical insurance. Each dentist billing medical insurance needs to be credentialed.

Pay Per Case

Verification of Benefit

$35 per vob

We get your patient’s insurance information so you can set proper expectations with the patient regarding the specific coverage available and any out of pocket fees. This is the most critical step in all of medical billing.

Per Authorization

$40 per auth

All procedures require pre-authorization in order for your practice to get paid. Gaining appropriate authorization can be challenging, let our experts get the job done for you.

Claim Submission

8% of successful claim

You don’t have time to sit on hold. Let us sit on hold and handle the claim submission work for you  We also handle the aging and appeals so you can focus on your practice.

Choose Your Software

Imagn Software is your one stop solution with both medical billing and dental sleep medicine capabilities with world-class support

What most dentist don’t know is that medical billing can increase your case acceptance rate and ensure your patients get the care they need.

Imagn Software

$195 /month

No contract and your satisfaction guaranteed.

Our goal is to give you the best experience. But if you are not satisfied then we will give you a full refund for your software access fee within 30 days of purchase.

Add Imagn Sleep Software

$100 /month

Our software provides everything you need

to give your patient’s the sleep care they deserve.

Patients can no longer afford to have dentists ignore the responsibility of providing care for sleep disorders. Two out of every three Americans report poor sleep; the ability to breathe well is the most important factor in determining a person’s sleep quality. 

Imagn Software Set-up Fee

$399 one-time fee

No contract and your satisfaction guaranteed.

Our goal is to give you the best experience. But if you are not satisfied then we will give you a full refund for your software access fee within 30 days of purchase.

Choose Your Monthly Devdent Support Program

In order for you to succeed, we offer a unique range of customer support solutions including coaching, online resources, implementation programming, and so much more. We keep an eye on the ever changing industry trends so you can focus on your practice

Medical Billing Support

$200 /month

The program to get and keep your staff trained.

Dental Sleep Medicine Support

$200 /month

The program to implement Dental Sleep Medicine into your practice.


$345 /month

Get both of the Medical Billing and Dental Sleep Medicine Support programs at a discount.

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