Enforcement of Medicare Part D Prescriber Enrollment Delayed

The Centers for Medicare & Medicaid Services has announced that it is once again delaying enforcement of the Medicare Part D prescriber enrollment requirement. Providers now need to enroll by January 1, 2019 instead of by February 1, 2017. For more information on the CMS delay, visit CMS.gov.

Dentists who prescribe Part D covered drugs to Medicare beneficiaries (all your patients over 65) must take one of the following three actions in order for these prescriptions to be covered by Medicare.

  1. Enroll as an ordering/referring provider (use form 855O or internet-based PECOS)
  2. Enroll as a Medicare provider (use form 855I or internet-based PECOS)
  3. Opt out of Medicare (not recommended – must submit opt-out affidavit and have a signed contract with every Medicare patient)
Doing nothing is NOT an option if your patients expect drugs you prescribe to be covered by Medicare.



Medicare Enrollment via PECOS

The quickest and easiest way to file any of the Medicare applications is online through the site called PECOS (Provider Enrollment, Chain and Ownership System for Medicare).

 

Medicare encourages you to use PECOS instead of the paper Medicare enrollment application. Advantages of using Internet-based PECOS include:

  • Faster than paper-based enrollment
  • Tailored application process means you supply only information relevant to your application
  • Completely paperless process, including electronic signature and digital document features

 

PECOS Enrollment Steps 

  1. To use PECOS go to: https://pecos.cms.hhs.gov/pecos/login.do#headingLv1. Use this same web page no matter which Medicare application (opt-in or ordering/referring provider) you intend to use. 
  2. Log in with your NPPES (the one you used on the NPI website) or PECOS username and password on the left side of the page. If you have never logged into the NPI website you can register for a user account on the right side of the page.
  3. Follow all the prompts to fill in all starred sections.
  4. When asked, sign in either as an Oral Surgeon (dentist) or Undefined Physician Type and enter Dentist in the space provided. Either option is fine for all dentists.
  5. When asked, your Fee-for-Service Contractor is: NATIONAL GOVERNMENT SERVICES, INC.
  6. After you submit the application they will allow you to e-sign the document. YOU DO NOT HAVE TO PRINT ANYTHING. Again, follow the prompts.

 

Be aware there is no application fee for dentists.

 

For enrollment questions not answered above, your Medicare Contractor, National Government Services, can be reached at (888) 379-3807.  

 


Helpful Medicare Links

PECOS Instructions - Detailed PDF showing how to use PECOS

Video Tutorial - Dentist specific video tutorial on using PECOS

CMS.gov - Official CMS (Centers for Medicare and Medicaid Services) Part D Prescriber Enrollment - Information for Dentists

ADA Medicare Resources - Resources including Medicare Decision Tree, Video Tutorial and FAQ