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Part D prescriber Enrollment Requirement Will Begin on January 1, 2019

By Christine Taxin
April 28, 2017


 

Prescribers, including dentists, who write prescriptions for Part D drugs are to be enrolled in an approved status or validly opted out with Medicare, in order for their patients’ prescriptions to be covered under Medicare Part D.

Full enforcement of Part D prescriber enrollment requirement will begin on January 1, 2019. In the lead-up to that date,

However, in the lead up to the January 1, 2019 full enforcement date CMS will begin targeted enforcement and through additional safeguards to increase prescriber enrollment, identify and eliminate vulnerabilities, and strengthen the Medicare Part D program. To learn more about these additional safeguards visit the Prescriber Enrollment Part D Home Page).

Why should a dentist enroll in Medicare to prescribe Part D drugs?

Approximately 100,000 dentists currently write prescriptions for Medicare Part D beneficiaries; enrollment is easy, free of charge, and can be done on-line in about 20 minutes
By enrolling in Medicare, a dentist assists the federal government in fighting fraud in the Medicare Part D program.
Fighting fraud in the Medicare Part D program is a high bipartisan priority of Congress.
Dentists can also assist the federal government in fighting fraud in the Medicare Part D program by making sure that the taxonomy associated with their NPIs reflect that they are a dentist (and not a dental assistant, resident, or hygienist, for example).
Unenrolled dentists’ Medicare patients may choose to find a dentist who is enrolled in Medicare so that their prescriptions are clearly coverable by the Part D program.
How can I enroll in Medicare?

Providers can enroll in Medicare by using either PECOS: go.cms.gov/pecos or by completing the paper 855I or 855O paper application.
By using internet-based PECOS to submit your enrollment application, Dentist can easily enroll in Medicare without paying expensive consulting firms.  Please visit the tutorial video on how to use internet-based PECOS at: Go.cms.gov/PECOSVideo.  This video is specific to dentists.
When submitting paper applications, the information should be submitted through their respective Medicare administrative contractors (MACs). Contact information for MACs can be found here: go.cms.gov/partdmaclist
CMS 855I – allows you to enroll to be reimbursed for the covered services furnished to Medicare beneficiaries, order and certify certain items or services, and prescribe Part D drugs.
Please note: If you are using the CMS 855I to enroll in Medicare to be reimbursed for covered services furnished to Medicare beneficiaries, select from either the Maxillofacial Surgery, Oral Surgery (dentist only), if applicable, or select Undefined Physician type and write in ‘General Dentist.’

CMS-855O – a shorter, abbreviated form, which allows you to enroll solely to order and/certify and/or prescribe Part D drugs. (While the CMS-855O form states it is for physicians and non-physician practitioners who want to order and refer, it is appropriate for use by prescribers who also want to enroll to prescribe Part D drugs.)
Please note:  CMS is updating the CMS-855O to include the General Dentist option. Until that form is updated, dentists should select from either the Maxillofacial Surgery, Oral Surgery (dentist only), if applicable, or select Undefined Physician type and write in ‘General Dentist’ on the CMS-855O.

If you choose not to enroll or opt out of Medicare, please be aware:

Unenrolled dentists’ Medicare patients will receive written notifications in the mail that their dentist is not qualified to write Part D prescriptions when the patients fill a prescription (which will only be covered on a provisional basis).
After a provisional supply of a drug has been covered, a Part D drug benefit plan will no longer cover a prescription written by an unenrolled dentist.   
Unenrolled dentists who contract with managed care plans to provide dental services to Medicare beneficiaries cannot opt-out.
Page last Modified: 10/31/2016 2:59 PM
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