A Simple Tool for Determining Dental Medicaid and Medicare Incentive Eligibility

Dentists and oral surgeons want a simple answer when questioning their eligibility for Medicaid and Medicare incentive payments for adopting and using Electronic Dental Records (EDRs). The National Network for Oral Health Access (NNOHA) provides this with their easy-to-use toolkit that walks providers through a series of yes and no questions. The tool is available openly online and requires no login. Eligible providers (EPs) cannot apply for both the Medicaid and Medicare programs. If you qualify for both, you should be aware that you will receive maximum benefit from the Medicaid program. Toolkit users should also:

“… start by assuming the dental EP did not perform 90% of the dental services in an inpatient hospital or emergency room hospital setting.”

Criteria for eligibility that are looked at include the percentage of patients seen that use Medicaid, Medicare, Children’s Health Insurance Program (CHIP) payments, Federally Qualified Health Centers (FQHC), or Rural Health Clinics (RHC), or are provided free care or care on a sliding schedule. Dental offices providing 30% or more of their services to patients meeting these criteria should explore the toolkit.

To qualify for meaningful use incentives, providers need to have adopted an Office of the National Coordinator for Health IT (ONC) certified Electronic Dental Record and reported on core and menu sets of objectives.

Lessons Learned:

  • The National Network for Oral Health Access has a simple toolkit to help dentists and oral surgeons determine eligibility for Medicaid and Medicare incentive payments for adopting and using Electronic Dental Records.
  • If 30% or more of your patients qualify for Medicare, Medicaid, or other federal programs, or receive free or reduced cost care from you, use this toolkit to help determine if you are eligible for EDR incentive payments.
  • Providers cannot apply for both Medicaid and Medicare incentives. Those qualifying for both will receive greater maximum benefit from the Medicaid program.

National Network for Oral Health Access. (2012) Eligible Provider Assessment.