The following editorial regarding Incurred Medical Expense (IME) appeared in the Jan/Feb 2013 issue of the CDS Review.
Penny wise, pound foolish
By Walter F. Lamacki, DDS
Editor, CDS Review
In June, Gov. Pat Quinn signed legislation extracting $2.7 billion from the state’s $14 billion Medicaid program, ostensibly to save the program. One of the changes is the elimination of coverage for adult dental care, a bankrupt idea that former Gov. Jim Edgar tried in the 1990s and had to abandon when emergency room costs skyrocketed, thus eliminating any phantom savings. The $51 million adult dental program represents about 2 percent of the cuts. A 2005 study by the Kaiser Foundation concluded that any savings from the elimination of adult care are miniscule.
While one door slammed shut another opened a crack for those, I believe, to be the most underserved population of patients: those 100,000 residents living in nursing homes in Illinois. Up until now, those who received care under Medicaid were treated by volunteers and a few Medicaid providers on a hit or miss basis — miss being the operative word. But a quirk in the maze of federal regulations can increase access to care for this neglected patient pool.
Incurred Medical Expense (IME), until now an obscure provision of the Medicare/Medicaid regulations, can help many residents of nursing homes receive necessary dental care. The resident must be enrolled in Medicaid and have some income, usually Social Security. Typically residents assign their Social Security payments to the facility to pay for their monthly fees. However, they do not relinquish total control of their Social Security checks. When a resident with Medicaid receives a bill for services not offered by the facility, they may qualify for IME. They can elect to apply their Social Security checks to pay their dental bills. In most cases, the dentists will be paid their usual and customary fees. Medicare then will reimburse the nursing home for the lost income. Most states do not require pre-treatment authorization.
Please visit www.ada.org for a more detailed explanation of IME and the steps dentists must take to receive payment for their services. We don’t know — at this time — what changes, if any, the Affordable Care Act will bring, but my guess is some similar program will be in place.
If you chose to take care of nursing home residents (and I hope you will), your treatment presents a whole new perspective. Patients can have diabetes, chronic heart failure and other chronic conditions. The most difficult condition you will face is varying degrees of dementia and its big brother, Alzheimer’s disease. As Shakespeare’s Hamlet tells us, “Old men are twice children;” compassion and patience will be valuable tools in your armamentarium.
You won’t have pretty pictures of your patient’s mouth, with a dozen pearly white porcelain veneers made possible by your persuasive skills. Many of the residents have outlived their closest relatives and seem to be warehoused out of sight and mostly forgotten. Improving the quality of their lives and giving them back their dignity will enrich you immeasurably.
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Teresa Duncan, founder of Odyssey Management, has a great
blog post on health care reform and dentistry.
It's an even-handed look at the good and bad in the bill for the
dental community. She writes:
Education wise - it's looking good. Grant money will
become available (separate from the $60 million) to provide
sealants to children, conduct studies on caries disease management
and keep school-based clinics running.....
[Legislators] changed the requirement for Medicaid so more will be
eligible but no consideration was given to increasing Medicaid
reimbursement. Dentists that offer Medicaid limit the numbers
within their practice - for good reason. You can easily lose money
treating Medicaid patients. It's not a selfish, motivated by big
bucks reason - it's a business decision. Maintaining quality with
increased quantity can only happen when you can scale the business.
Since most dentists are solo practitioners this is impractical so
they have to limit the Medicaid quantity.