DOH Issues Dental Billing Reminder

Last week, the Department of Health (DOH) issued a letter reminding providers that dental services for nursing home residents whose care is covered by Medicaid are included in the home’s Medicaid rate. The reminder comes in the wake of a recent Medicaid billing system review that found overpayments. These occurred when providers claimed separate reimbursement for dental services for nursing home residents despite these services being included within the nursing home rate. The Dear Provider Letter is available here.

The eMedNY Dental Policy and Procedure Manual, updated in 2019, is available here. Billing for nursing home residents is addressed on page 15:

Dental services are included in the facility rates. Payment for services to residents of such facilities will not be made on a fee-for-service basis. It is the responsibility of the facility to make arrangements for the provision of all dental services listed in the Provider Manual either within the facility or with area providers. Claims should not be submitted by either the provider(s) or facility for covered dental services or for transportation.

DOH is fielding questions on this issue at nfrates@health.ny.gov. Please indicate “Dental Billing” in the subject line.

Contact: Darius Kirstein, dkirstein@leadingageny.org, 518-867-8841