by Christine Woolstenhulme, QCC, QMCS, CPC, CMRS
July 13th, 2015
Are you aware you must be participating with Medicare Part D to be eligible to prescribe medication's to patients that have Medicare? If you are not participating, your patients will not be able to fill their prescriptions.
You may also enroll to become an ordering and referring Medicare provider. You will not be recognized as a Medicare Provider, but your orders and referrals for testing, services, or care by subsequent providers will be paid based on your participation as an ordering physician.
For example: If you refer a Medicare patient to OMS for an evaluation of an oral lesion and the results are cancerous, the patient is then referred to oncology. If you are participating as a referring Medicare provider both the OMS and the oncologist will be reimbursed for their services, which started from your referral. If you are not participating, Medicare will not pay for the service from a referral from a Non-Par provider. Referring physicians and their NPI's are required to be on the CMS-1500 claim form when submitting a claim to Medicare.